Abstract 4554: Drug-eluting vs. Bare-metal Stents for the Treatment of ST-elevation Myocardial Infarction: Three-year Clinical Outcome of the MISSION! Intervention Study
Objective: To compare the long-term efficacy and safety of sirolimus-eluting stents (SES) to bare-metal stents (BMS) for the treatment of acute ST-segment myocardial infarction (STEMI).
Method: All 310 consecutive patients (age 59±11years, 78% male) from the single-blind, single-center, randomized MISSION-intervention study were followed for a median 38 months. Clinical end points were death, myocardial infarction, target vessel/lesion revascularization, target vessel failure (composite of all end points related to the target vessel) and stent thrombosis according to the Academic Research Consortium definition. All patients were treated with aspirin (lifelong) and clopidogrel for 1 year after stent implantation.
Results: There were no significant differences in baseline and angiographic characteristics between the treatment groups (158 SES, 152 BMS). After three years the cumulative incidence in SES and BMS treated patients was similar for cardiac death (2.7% vs. 3.8%; p=0.69) and myocardial infarction (7.9% vs. 11.9%; p=0.29). There was a slightly lower cumulative incidence in SES treated patients for target vessel revascularization (9.4% vs. 16.8%; p=0.06), target lesion revascularization (6.8% vs. 13%; p=0.08) and target vessel failure (12.5% vs. 21%; p=0.06) at three years. However, the cumulative rate of definite stent thrombosis at 3.5 years follow up was higher in SES patients than in BMS patients (4.0% vs. 0.7%; p=0.11) with the difference in event distribution reaching statistical significance for occurrence of very late (>1year) stent thrombosis (3.3% vs. 0%; p=0.05).
Conclusion: After 3 years SES treated STEMI patients continued to demonstrate a trend toward favorable clinical outcome for target vessel revascularization at the cost of a higher incidence of very late stent thrombosis.