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Comparative Study
. 2014 Apr;63(4):296-301.
doi: 10.1016/j.jjcc.2013.09.007. Epub 2013 Dec 22.

Comparison between drug-eluting and bare metal stent on ST-elevation myocardial infarction outcome: should second-generation drug-eluting stent be preferred?

Cristina Giglioli  1 , Emanuele Cecchi  2 , Leonard Vladi  2 , Miroslava Stolcova  2 , Serafina Valente  2 , Francesco Meucci  2 , Giorgio Jacopo Baldereschi  2 , Marco Chiostri  2 , Salvatore Mario Romano  2 , Gian Franco Gensini  2 , Alessandro Barchielli  3 , Daniela Balzi  3
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Free article
Comparative Study

Comparison between drug-eluting and bare metal stent on ST-elevation myocardial infarction outcome: should second-generation drug-eluting stent be preferred?

Cristina Giglioli et al. J Cardiol. 2014 Apr.
Free article

Abstract

Background and purpose: Although several studies reported that drug-eluting stents (DES) are able to reduce restenosis incidence without increasing mortality, concerns still exist about their safety in ST-segment elevation myocardial infarction (STEMI) patients mainly for a possible higher rate of in-stent thrombosis. Recent evidence suggests a better safety profile of second-generation DES, but data on their outcome in STEMI are still poor. In this study we evaluated the impact on mortality and target lesion revascularization (TLR) of DES or bare metal stent (BMS) implantation in STEMI patients submitted to primary angioplasty.

Methods and subjects: We analyzed mortality and TLR in 1150 STEMI patients during a mean 43-month follow-up after DES (44.6%) or BMS (55.4%) implantation. A propensity score method was used to minimize bias. During follow-up, 223 deaths occurred.

Essential results: Unadjusted for potential confounders, DES implantation was associated with a significant reduction in all-cause mortality [hazard ratio (HR) 0.40; 95%CI 0.30-0.54] and TLR (HR 0.55; 95%CI 0.36-0.86); this latter was confirmed after propensity score analysis (HR 0.39; 95%CI 0.21-0.67). Second- (n=179) vs. first- (n=337) generation DES showed a further reduction in TLR (HR 0.17; 95%CI 0.05-0.57). Adjusted analyses showed a significant reduction in the combined end-point of all-cause mortality or TLR after both first- and second-generation DES vs. BMS implantation with a trend to a lower risk for second- vs. first-generation DES.

Principal conclusions: DES implantation in STEMI patients showed a significant reduction in TLR and in the combined endpoint of TLR or mortality. Second-generation DES showed a more protective effect on the combined endpoint, suggesting that they would be preferred in this setting.

Keywords: Bare metal stent; Drug-eluting stent; Outcome; Primary PCI; STEMI.

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