Abstract 15082: Drug-Eluting Stents Reduce Mortality Compared to Bare-Metal Stents in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention
Introduction: Percutaneous coronary intervention (PCI) is the recommended reperfusion strategy for patients presenting with ST-elevation myocardial infarction (STEMI). Operators are to choose between bare metal (BMS) and drug-eluting stents (DES) without substantial comparative evidence of clinical efficacy and safety.
Methods: Prospectively collected data from 1/1/11 till 12/31/12 at 2 tertiary care centers in the New York area was obtained. Univariate, bivariate and multivariate analyses, and propensity score matching were performed. The primary endpoint was death (index admission or 30-day), the secondary being adverse outcome (death, dissection, perforation, MI, CVA, bleeding, transfusion, or CABG).
Results: Among the 1,442 patients presenting with STEMI who underwent PCI (1,101 DES, 342 BMS) BMS patients were older, more often of white race and female gender, with higher prevalence of previous surgery (valve or bypass), bigger vessel diameter, and smaller stent length than DES patients. DES use was associated with lower mortality (1% vs 7%, p<0.001) and adverse outcomes (23% vs 7%, p<0.001). In multivariate logistic regression analyses DES had lower mortality (OR 0.03, p=0.007) and adverse outcomes (OR 0.09, p<0.001). In propensity scoring with nearest neighbor matching the results were similar (mortality OR 0.07 (p<0.001), adverse outcomes OR 0.13 (p<0.001)).
Conclusions: DESs have lower mortality and adverse outcomes in STEMI patients undergoing PCI and may be considered as the preferred option in revascularization. This study is limited by its registry-based observational design, hence the importance of future randomized prospective trials.
- © 2013 by American Heart Association, Inc.