Abstract 5614: Primary Percutaneous Coronary Intervention For Acute Myocardial Infarction: Long-term Outcome Following Bare Metal And Drug-eluting Stent Implantation
Background: Primary percutaneous coronary intervention (PPCI) with bare metal stents (BMS) is well established, whilst randomized trials suggest equivalent safety and reduced repeat revascularization with drug-eluting stents (DES) in this setting. However, long-term data on the role of DES in patients undergoing PPCI is lacking, especially in those ineligible for inclusion in randomized trials, with particular concerns regarding the risk of stent thrombosis. Our aim was to investigate the long-term clinical outcomes of unselected patients undergoing PPCI with BMS and DES at a single academic medical centre.
Methods and results: We analyzed all patients (n=1738) undergoing PPCI for a de novo lesion in an academic medical center from 2000 –2005. Patients from 3 sequential consecutive cohorts of bare metal (BMS: n=531), sirolimus-eluting (SES: n=185) or paclitaxel-eluting stents (PES: n=1022) were included. The median duration of follow-up was 1185 days. There were no differences in all-cause mortality between the 3 stent types, although there was a non-significant trend towards improved survival with SES compared to both BMS (propensity score-adjusted HR 0.56 [95%CI 0.29 –1.08]) and PES (HR 0.64 [95% CI 0.36 –1.16]). After propensity score adjustment, SES were associated with lower rates of the composite endpoints of all-cause death or nonfatal myocardial infarction (HR 0.56, 95%CI 0.34 – 093) and death, nonfatal MI or target vessel revascularization (HR 0.61, 95%CI 0.40 – 0.95) when compared to PES. Very late stent thrombosis only occurred in the DES groups.
Conclusions: DES are not associated with an increase in adverse events compared to BMS when used for PPCI and there was a trend towards improved survival with SES. Neither DES reduced repeat revascularizations. Ongoing follow-up is required to assess the continued risk of very late stent thrombosis with DES. Appropriately powered randomized trials with an “all-comer” design, hard clinical endpoints and long-term follow-up are required to confirm or refute these findings.