Everolimus-eluting stent versus bare metal stent in proximal left anterior descending ST-elevation myocardial infarction

• Published in: The American heart journal 2013-07, Vol.166 (1), p.119-126.e1
• Main Authors: Gomez-Lara, Josep, MD PhD, Brugaletta, Salvatore, MD PhD, Gomez-Hospital, Joan-Antoni, MD PhD, Ferreiro, Jose Luis, MD, Roura, Gerard, MD, Romaguera, Rafael, MD, Martin-Yuste, Victoria, MD, Masotti, Monica, MD, PhD, Iñiguez, Andrés, MD, PhD, Serra, Antonio, MD, PhD, Hernandez-Antolin, Rosana, MD, PhD, Mainar, Vicente, MD, PhD, Valgimigli, Marco, MD, PhD, Tespili, Maurizio, MD, PhD, den Heijer, Pieter, MD, PhD, Bethencourt, Armando, MD, PhD, Vazquez, Nicolás, MD, PhD, Serruys, Patrick, MD, PhD, Sabate, Manel, MD, PhD, Cequier, Angel, MD, PhD
• Format: Article
• Language: English
• Subjects: Cardiovascular; Clinical outcomes; Diabetes; Heart attacks; Mortality; Normal distribution; Population; Stents; Thrombosis
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2013.04.012

Background ST-elevation myocardial infarctions (STEMI) caused by proximal left-anterior descending (LAD) lesions have more myocardium at risk and worse outcomes than those located in other segments. The aim is to compare outcomes of patients with STEMI and proximal-LAD lesions treated with bare-metal stents (BMS) versus everolimus-eluting stents (EES). Methods The EXAMINATION trial randomized 1498 STEMI patients to BMS versus EES. The primary end point was the patient-oriented combined of all-cause death, any-recurrent myocardial infarction (MI) and any-revascularization. The secondary end point included the device-oriented combined of cardiac death, target-vessel MI and target-lesion revascularization (TLR). Results STEMI with a proximal-LAD occlusion was observed in 290 patients (BMS = 132 and EES = 158). Both groups were similar except for diabetes (12.9% vs 24.1%; P = .016). At 1 year, the primary end point was observed in 18.9% and 9.5% of patients treated with BMS and EES, respectively ( P = .023). The secondary end point was observed in 11.4% and 5.1%, respectively ( P = .053). There were no differences in cardiac death (4.5% vs 3.8%; P = .750) and MI (1.5% vs 0%; P = .121). BMS had higher rate of TLR compared to EES (6.8% vs 1.3%; P = .014). Patients with proximal-LAD STEMI had higher mortality than patients with non proximal-LAD STEMI (5.5% vs 2.9%; P = .027). Proximal-LAD lesions treated with BMS tended to increase the risk of the primary end point compared with other segments (18.9% vs 13.0%; P = .079). However, EES implanted in proximal-LAD had similar outcomes compared with other locations (9.5% vs 12.0%; P = .430). Adjusting for confounders, the interaction between BMS and proximal-LAD location was associated with the primary end point. Conclusion Patients with STEMI and proximal-LAD lesions treated with EES have better outcomes compared with BMS at 1 year. Although further investigations are required, it seems reasonable to consider EES for proximal-LAD STEMI-lesions.