Comparison of long-term outcomes in STEMI and NSTE-ACS after coronary stent placement: an analysis in a real world BMS and DES population

• Published in: International journal of cardiology 2013-09, Vol.167 (5), p.2082-2087
• Main Authors: van Leeuwen, Maarten A.H, Daemen, Joost, van Mieghem, Nicolas M, de Boer, Sanneke P.M, Boersma, Eric, van Geuns, Robert J, Zijlstra, Felix, van Domburg, Ron T, Serruys, Patrick W.J.C
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - epidemiology; Acute Coronary Syndrome - surgery; Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Cohort Studies; Coronary heart disease; Drug-Eluting Stents - trends; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - epidemiology; Myocardial Infarction - surgery; Myocarditis. Cardiomyopathies; NSTE-ACS; Outcome; PCI; Percutaneous Coronary Intervention - trends; Population Surveillance - methods; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Registries; STEMI; Stent; Stents - trends; Treatment Outcome
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2012.05.064

Abstract Background/Objectives The prognostic difference between STEMI and NSTE-ACS after coronary stent placement remains unclear. We aimed to compare the short- and long-term event rates in patients presenting with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI) with either bare-metal stents (BMS) or drug-eluting stents (DES). Methods Between 2000 and 2005 a total of 1749 STEMI and 1921 NSTE-ACS patients received either a BMS or DES in consecutive real world cohorts. Descriptive statistics and multivariate survival analyses were applied to compare the event rates in STEMI and NSTE-ACS during 4 years follow-up. Results NSTE-ACS patients had significantly higher clinical and angiographic risk profiles at baseline and were treated with less optimal medical therapy during follow-up. At 4 years follow-up, all-cause mortality was significantly higher in STEMI compared to NSTE-ACS after coronary stent placement (17.4% vs. 14.3%; HR 1.60, 95% CI 1.24–2.07). In a landmark analysis no difference was seen in all-cause mortality among STEMI en NSTE-ACS between 1 month and 4 years follow-up (HR 1.10, 95% CI 0.81–1.51). Cardiac death was more prevalent in STEMI patients, while the 4-year cumulative incidences of any myocardial infarction, any coronary revascularization, target lesion revascularization and definite stent thrombosis were similar in both ACS groups. Conclusions Patients presenting with STEMI have a worse long-term prognosis compared to NSTE-ACS after coronary stent placement, due to higher short-term death rates. However, after the first month STEMI and NSTE-ACS patients have a comparable long-term survival.