Abstract 15231: Long-Term Clinical Outcome in STEMI-Patients Treated With Primary PCI and Drug-Eluting or Bare-Metal Stents
Background: Use of drug-eluting stents (DES) in patients with ST-segment Elevation Myocardial Infarction (STEMI) during routine primary percutaneous coronary intervention (pPCI) is controversial. We evaluated 4-year clinical outcome in a consecutive STEMI-population treated with DES or bare-metal stents (BMS).
Methods and results: From January 2004 to July 2008, 2,155-STEMI patients were treated with pPCI at a single high volume invasive center. We present 4-year outcome in this observational registry study. A total of 1,725 were treated with DES and 430 were treated with BMS. Patients treated with DES were younger and had more complex angiographic characteristics compared to BMS-patients. Compliance of clopidogrel-medication was high (90%) and identical in the two groups. Patients treated with DES had lower adjusted risk of Target Lesion Revascularization (TLR) (HR: 0.58; 95% CI 0.38–0.88; P=0.01), but increased adjusted risk of having a non-fatal MI in the culprit vessel (HR 2.21; 95% CI 1.05–4.66; p=0.04). Furthermore, a trend towards increased risk of definite Stent Thrombosis for DES-patients was found (HR: 1.96; CI 0.83–4.61; p=0.12).
Conclusions: In concordance with other studies we found that DES-use was associated with reduced risk of in-stent restenosis, but up to 4 years of follow-up DES-treated patients were more likely to have a non-fatal MI in the culprit vessel and Stent-Thromboses. The advantage of lower TLR-rate in DES-patients may be counterbalanced by this important safety-issue, and focus on stent-delivery and clopidogrel-compliance is still essential when deciding on the treatment-strategy in STEMI-patients. Furthermore, additional long-term follow-up, preferably from RCT, is needed.
- © 2010 by American Heart Association, Inc.