'Real world' comparison of drug-eluting stents vs bare metal stents in the treatment of unselected patients with acute ST-segment elevation myocardial infarction

Abstract

Background: Concerns exist regarding the long-term efficacy and safety of drug-eluting stents (DES) in patients with ST-segment elevation myocardial infarction (STEMI). The study aimed to compare the mid- to long-term outcomes of DES vs bare metal stents (BMS) in patients with STEMI in a real-world setting. Methods and Results: Six hundred and eighty four consecutive patients with STEMI who underwent percutaneous coronary intervention from January 2003 to December 2006 were analyzed; 539 patients (78.8%) with DES and 145 (21.2%) with BMS. Patients were followed for the occurrence of target vessel failure (TVF); a composite of cardiac death, non-fatal myocardial infarction, or target vessel revascularization (TVR). After a follow-up duration of 36 months, the TVF rate was significant lower in the DES group compared with the BMS group (17.8% vs 34.5%, P<0.01), which was mainly driven by a decrease in TVR (9.1% vs 22.8%, P<0.01). Diabetic patients, those with multivessel disease and those treated with smaller or longer stents benefited more from DES implantation. Propensity score matching concordantly indicated a benefit of DES with regard to TVF (13.5% vs 34.2%; P<0.01). The overall incidence of stent thrombosis (ST) in each group was comparable (3.9% vs 4.1%, P=0.47). Conclusions: Compared to BMS, the mid- to long-term outcome was better in patients receiving DES for acute STEMI. This was driven mainly by a reduction in repeat revascularization.