Abstract 13959: Drug Eluting Stents versus Bare Metal Stents in Large Coronary Arteries During Primary Percutaneous Coronary Intervention
Background: Recent data has suggested that patients with coronary disease in large arteries are at increased risk for late cardiac events after percutaneous coronary intervention (PCI) with first-generation drug-eluting stents (DES), as compared with bare-metal stents (BMS). A recent study suggested there was no difference in elective procedures. We sought to investigate this observation in patients undergoing Primary PCI.
Method: 2447 consecutive patients undergoing Primary PCI for STEMI at a London centre between Oct 2003 and May 2010 were included. The primary end point used was major adverse cardiac events (MACE), defined as death, myocardial infarction (MI), stroke and target vessel revascularization (TVR).
Results: Of the 2447 patients, 933 required stents between 3 and 4mm in diameter. Of these 809 were BMS and 124 DES. The DES treated group had higher rates of diabetes (22% vs 13% p = 0.01), previous MI (20% vs 12%, p = 0.02) and previous PCI (10% vs 5%, p=<0.04). There was a higher average number of stents used in the DES group (1.7 vs 1.5, p =0.03) and a higher average stent length in the DES group (19.12 vs 16.05, p=0.002). There was a significant difference in MACE between the two groups in favour of DES (12% BMS v 5% DES group [p = 0.04) at 3 years (figure 1). The rate of target-vessel revascularization was significantly reduced among patients receiving either drug-eluting stent, as compared with a bare-metal stent with TVR rates of 2.2% among patients receiving DES compared to 8.1% among those receiving bare-metal stents (p = 0.03). There were no significant differences in the rate of death, myocardial infarction, or stent thrombosis.
Conclusion: In patients requiring stenting of large coronary arteries during primary PCI, there was reduced MACE in patients treated with DES. This benefit was primarily driven by decreased target vessel revascularisation.
- © 2011 by American Heart Association, Inc.