Abstract 21442: Determinants of Bare Metal Stent Use in Patients with ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Cronary Intervention
Introduction: Bare metal stent (BMS) use in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has been associated with higher rates of adverse cardiac events, including target lesion and target vessel revascularization. The purpose of the present study was to determine which clinical characteristics predict BMS use in patients with STEMI undergoing primary PCI.
Methods: A cohort of 1,649 patients with STEMI undergoing primary PCI between January 1, 2004 and December 31, 2007 at four New York State teaching hospitals were retrospectively studied. Two hundred fifty-five patients were excluded if they had received both a BMS and a drug-eluting stent (DES) or neither. Of the remaining 1,394 patients, demographics, baseline medical history, procedural characteristics, and in-hospital outcomes were compared in patients receiving DES versus BMS.
Results: Among 1,394 patients, a total of 290 (20.8%) patients received a BMS while 1104 (79.2%) received a DES. Patients receiving a BMS were more likely to be Hispanic (9% vs 6%, p=0.031) and uninsured (11% vs 6%, p=0.001), and less likely to be insured by a private managed care plan (17% vs 29%, p<0.001). They also had worse left ventricular ejection fraction (LVEF) (43% vs 46%, p<0.001), and higher rates of prior coronary artery bypass graft sugery (7% vs 4%, p=0.018), prior PCI (21% vs 16%, p=0.033), peripheral vascular disease (9% vs 4%, p=0.002), diabetes (22% vs 16%, p=0.034), and history of prior stent thrombosis (5% vs 2%, p=0.001). Patients receiving a BMS has significantly longer hospital length of stay (5.7 vs 4.9 days, p=0.034) and a trend toward higher all-cause in-hospital mortality (3.8% vs 2.0%, p=0.073). In multivariate analysis, determinants of BMS use included uninsured status (OR 1.91, 95%CI: 1.17–3.12), private managed care plan (OR 0.50, 95%CI: 0.34–0.74), prior PCI (OR 1.66, 95%CI: 1.16–2.37), peripheral vascular disease (OR 2.27, 95%CI: 1.28–4.03), and LVEF (OR 0.98, 95%CI: 0.97–0.99).
Conclusions: Absence of health insurance or private managed care plan, peripheral vascular disease, prior PCI, and lower LVEF are all independent predictors of BMS use in patients with STEMI undergoing primary PCI.
- © 2010 by American Heart Association, Inc.