Mortality following placement of drug-eluting and bare-metal stents for ST-segment elevation acute myocardial infarction in the Global Registry of Acute Coronary Events
Department of Medicine, Division of Cardiovascular Medicine
Medical Subject Headings
Aged; Angioplasty, Transluminal, Percutaneous Coronary; Drug-Eluting Stents; Electrocardiography; Epidemiologic Methods; Female; Humans; Male; Middle Aged; Myocardial Infarction; Stents
AIMS: To assess mortality after drug-eluting stent (DES) or bare-metal stent (BMS) for ST-segment elevation myocardial infarction (STEMI).
METHODS AND RESULTS: In this multinational registry, 5093 STEMI patients received a stent: 1313 (26%) a DES and 3780 (74%) only BMS. Groups differed in baseline characteristics, type, or timing of percutaneous coronary intervention, with a higher baseline risk for patients receiving BMS. Two-year follow-up was available in 55 and 60% of the eligible BMS and DES patients, respectively. Unadjusted mortality was lower during hospitalization, similar for the first 6 months after discharge, and higher from 6 months to 2 years, for DES patients compared with that of BMS patients. Overall, unadjusted 2-year mortality was 5.3 vs. 3.9% for BMS vs. DES patients (P = 0.04). In propensity- and risk-adjusted survival analyses (Cox model), post-discharge mortality was not different up to 6 months (P = 0.21) or 1 year (P = 0.34). Late post-discharge mortality was higher in DES patients from 6 months to 2 years (HR 4.90, P = 0.01) or from 1 to 2 years (HR 7.06, P = 0.02). Similar results were observed when factoring in hospital mortality.
CONCLUSION: The observation of increased late mortality with DES vs. BMS suggests that DES should probably be avoided in STEMI, until more long-term data become available.
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Citation: Eur Heart J. 2009 Feb;30(3):321-9. Epub 2009 Jan 15. Link to article on publisher's site
Steg PG, Fox KA, Eagle KA, Furman MI, Van de Werf F, Montalescot G, Goodman SG, Avezum A, Huang W, Gore JM. (2009). Mortality following placement of drug-eluting and bare-metal stents for ST-segment elevation acute myocardial infarction in the Global Registry of Acute Coronary Events. Clinical & Population Health Research. Retrieved from https://escholarship.umassmed.edu/gsbs_cphr/21