Abstract 14452: Long Term Outcomes With Selective Drug Eluting Stent Use in ST-Elevation Myocardial Infarction in an Australian Urban Population
Background and objectives: Drug Eluting Stent (DES) use in primary percutaneous intervention for ST elevation myocardial infarction (STEMI) reduces the risk of in-stent restenosis. However, it does not provide a mortality benefit and is associated with an increased incidence of late stent thrombosis.
The aim of the study was to assess the long-term outcomes of the selective use of DES in STEMI patients at high risk of in-stent re-stenosis.
Methods: Consecutive patients that presented in the period between April 2004 and January 2012 to a single centre were prospectively enrolled into the study. Patients treated with primary angioplasty were grouped into two cohorts based on pre-specified criteria: those at high risk for in-stent restenosis (46%, n= 847) who received DES and those at low risk who received bare metal stents (BMS) (54%, n= 985).
The lesion characteristics used to differentiate subjects into the high-risk group were: target vessel ≤ 2.5mm in diameter in non-diabetic patients and ≤ 3.0mm in diabetic patients; target vessel lesion length >18mm; previous in-stent restenosis; saphenous vein graft lesions; ostial lesions; bifurcation lesions; left main coronary artery lesions; and multi-vessel disease.
Results: Patients were followed up for a median period of 24 months (inter-quartile range 6-35 months). Baseline patient characteristics were similar between the two groups. At 24 months there was no significant difference (DES vs BMS) in MACE (10.1% vs 14.9%, p= 0.070), mortality (7.6% vs 10.4%, p= 0.327), definite stent thrombosis (2.2% vs 1.6%, p= 0.094) or target vessel revascularization (1.4% vs 1.4%, p= 0.512). Patients who received DES had a lower rate of clinically driven target lesion revascularisation (1.8% vs 4.2%, p= 0.026).
Conclusion: Selective use of DES in STEMI patients appears to provide satisfactory long-term outcomes and reduce the number of patients exposed to the risks and costs associated with DES.
- © 2013 by American Heart Association, Inc.