Clinical outcomes of second-generation limus-eluting stents compared to paclitaxel-eluting stents for acute myocardial infarction with cardiogenic shock

• Published in: PloS one 2019-04, Vol.14 (4), p.e0214417-e0214417
• Main Authors: Mao, Chun-Tai, Chen, Tien-Hsing, Tseng, Chi-Nan, Chen, Shao-Wei, Hsieh, I-Chang, Hung, Ming-Jui, Chu, Pao-Hsien, Wang, Chao-Hung, Wen, Ming-Shien, Cherng, Wen-Jin, Chen, Dong-Yi
• Format: Article
• Language: English
• Subjects: Aged; Analysis; Antineoplastic agents; Biology and Life Sciences; Cardiac patients; Cardiogenic shock; Cardiology; Care and treatment; Cerebral infarction; Clinical outcomes; Codes; Complications and side effects; Coronary artery bypass; Coronary Artery Bypass - methods; Coronary Artery Bypass - mortality; Coronary vessels; Data processing; Diabetes; Dopamine; Dosage and administration; Drug dosages; Drug-Eluting Stents; Everolimus; Female; Heart attack; Heart attacks; Heart failure; Heart Failure - drug therapy; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - surgery; Heart surgery; Hospitals; Humans; Implantation; Implants; Internal medicine; Ischemia; Kaplan-Meier Estimate; Male; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Myocardial infarction; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardial Infarction - surgery; National health insurance; Online databases; Paclitaxel; Paclitaxel - administration & dosage; Patients; Percutaneous Coronary Intervention - methods; Percutaneous Coronary Intervention - mortality; Physical Sciences; Risk; Risk Factors; Shock; Shock, Cardiogenic - drug therapy; Shock, Cardiogenic - mortality; Shock, Cardiogenic - physiopathology; Shock, Cardiogenic - surgery; Stents; Stroke; Surgery; Surgical implants; Treatment Outcome; Veins & arteries
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0214417

Whether the cardiovascular (CV) outcomes of second-generation limus-eluting stents (LESs) differ from those of paclitaxel-eluting stents (PESs) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is still unclear. We used the Taiwan National Health Insurance Research Database to analyse data of 516 patients with AMI and CS diagnosed from January 2007 to December 2011. We used propensity score matching to adjust for the imbalance in covariate baseline values between these two groups. We evaluated clinical outcomes by comparing 197 subjects who used second-generation LESs to 319 matched subjects who used PESs. The risk of the primary composite outcomes (i.e., myocardial infarction, coronary revascularisation or CV death) was significantly lower in the second-generation LES group than in the PES group [37.3% vs. 51.8%; hazard ratio (HR), 0.73; 95% CI: 0.56-0.95] at the 12-month follow-up. The patients who received second-generation LESs had a lower risk of coronary revascularisation (HR 0.62; 95% CI: 0.41-0.93) than those who used PESs. However, the risks of myocardial infarction (HR 0.56; 95% CI: 0.26-1.24), ischemic stroke (HR 0.73; 95% CI: 0.23-2.35), or CV death (HR 0.90; 95% CI: 0.63-1.28) were not significantly different between the two groups. Among patients with CS-complicating AMI, second-generation LES implantation significantly reduced the risk of coronary revascularisation and composite CV events compared to PES implantation at the 12-month follow-up.