Long-Term Safety and Effectiveness of Drug-Eluting Stents Compared to Bare Metal Stents in ST Elevation Myocardial Infarction: Findings from the Guthrie Health Off-Label Stent (GHOST) Registry
| Autor: | Kishore J. Harjai, Sudhakar Sattur, Pam Orshaw, Judy Boura |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Bare-metal stent
medicine.medical_specialty business.industry medicine.medical_treatment Incidence (epidemiology) Percutaneous coronary intervention Stent medicine.disease Surgery Conventional PCI medicine Radiology Nuclear Medicine and imaging cardiovascular diseases Myocardial infarction Cardiology and Cardiovascular Medicine business Survival analysis Mace |
| Zdroj: | Journal of Interventional Cardiology. 25:118-125 |
| ISSN: | 0896-4327 |
| DOI: | 10.1111/j.1540-8183.2011.00703.x |
| Popis: | Background: Multiple randomized trials and observational studies have shown drug-eluting stents (DES) to be safe and effective at 3-year follow-up in stent thrombosis (ST)-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). However, outcomes data beyond 3–4 years after DES implantation are sparse. Methods: We studied 554 STEMI patients who underwent successful PCI with either DES or bare metal stent (BMS). Primary study end-points were time to occurrence of ST and the composite of death or myocardial infarction (MI). Secondary end-points were time to occurrence of major adverse cardiac events (MACEs) and discrete events that comprise MACE (death, MI, and target vessel revascularization [TVR]). Outcomes of the DES and BMS groups were assessed by survival analysis and multivariable Cox regression. Results: There were 205 (37%) patients who received DES and 349 (63%) patients who received BMS. At a median follow-up of 41.4 months after PCI, there were no differences in the unadjusted incidence of ST (ST, 3.4 vs. 4.3%, log-rank P = 0.61) and MI (6.8% vs. 8%, P = 0.61) between DES versus BMS groups, respectively. However, DES implantation was associated with lower unadjusted incidence of death or MI (11% vs. 23.5%, P = 0.0002), MACE (16% vs. 34%, P < 0.0001), death (6.3% vs. 17%, P = 0.0004), and TVR (9.8% vs. 18%, P = 0.008) than BMS implantation. In multivariable analyses, DES implantation was associated with significantly lower incidence of MACE (adjusted HR = 0.47 [95% CI: 0.31–0.76], P = 0.0007) than BMS implantation. Conclusion: In our study of STEMI patients, DES implantation was safer than BMS implantation and was associated with lower MACE at long-term follow-up. (J Interven Cardiol 2012;25:118–125) |
| Databáze: | OpenAIRE |
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