Risk of Heart Failure in Patients with ST-Elevation Myocardial Infarction Receiving Drug-Eluting Stent Implantation and Undefined Duration of Antiplatelets

Abstract

It remains unknown as to whether the use of new-generation drug-eluting stent (NG-DES) in patients with ST-elevation myocardial infarction (STEMI) who receive an undefined duration of dual antiplatelet therapy (DAPT) reduces the risk of hospitalization for heart failure (HHF). In this population-based retrospective cohort study, we applied propensity score matching to select 6831 pairs of patients with STEMI who had similar baseline characteristics and received either NG-DES or bare-metal stent (BMS) implantation between 1 January 2007 and 31 December 2016. The risk of stent-associated HHF was evaluated, wherein death was considered a competing risk. Rates of cumulative incidence competing risk for HHF at the 1, 2, 3, 4, and 5 year follow-up were lower in the NG-DES group (3.79%, 5.21%, 6.15%, 7.01%, and 8.29%, respectively) than in the BMS group (4.51%, 6.21%, 7.32%, 8.33%, and 9.83%, respectively). NG-DES implantation was associated with a lower risk of HHF than BMS implantation after 5 years, with an adjusted subdistribution hazard ratio of 0.82 (95% confidence interval 0.72−0.92, p = 0.001). These results accord with those of patients who received DAPT for >6 months. Our findings highlight that NG-DESs may reduce HHF risk in patients with STEMI receiving an undefined duration of DAPT.

Keywords: ST-elevation myocardial infarction; bare-metal stent; drug-eluting stent; heart failure.

Figure 1

Patient selection process. ARNI—angiotensin receptor/neprilysin inhibitor; BMS—bare-metal stent; CABG—coronary artery bypass grafting; DES—drug-eluting stent; HF—heart failure; MI = myocardial infarction; N—number; NG-DES—new-generation drug-eluting stent; NSTEMI—non-ST-elevation myocardial infarction; PCI—percutaneous coronary intervention; PSM—propensity score matching; STEMI—ST-elevation myocardial infarction; VAD—ventricular assist device.

Figure 2

Cumulative incidence of HHF for competing risk among patients with STEMI receiving NG-DES or BMS implantation. BMS—bare-metal stent; CI—confidence interval; CICR—cumulative incidence competing risk; HHF—hospitalization for heart failure; NG-DES—new-generation drug-eluting stent; SHR—subdistribution hazard ratio; STEMI—ST-elevation myocardial infarction.

Figure 3

Subgroup analysis of the risk of HHF among patients with STEMI receiving NG-DESs (reference group) and BMSs. Adjusted SHR was adjusted for baseline covariates, including age, sex, year of index MI admission, comorbidities, prescribed medications, use of IABP during PCI, multivessel PCI, CHA₂DS₂-VASc scores, ORBIT scores, and various ARC criteria for HBR. Abbreviations are defined in the footnote of Table 1.