Comparison of Paclitaxel and Everolimus-eluting Stents in ST-segment Elevation Myocardial Infarction and Influence of Thrombectomy on Outcomes. ESTROFA-IM Study

• Published in: Revista española de cardiología (English ed.) 2014-12, Vol.67 (12), p.999-1006
• Main Authors: de la Torre Hernández, José M., Alfonso, Fernando, Martin Yuste, Victoria, Sánchez Recalde, Angel, Jimenez Navarro, Manuel F., Pérez de Prado, Armando, Hernández, Felipe, Abdul-Jawad Altisent, Omar, Roura, Gerard, García Camarero, Tamara, Elizaga, Jaime, Calviño, Ramón, Moreu, Jose, Bosa, Francisco, Jimenez Mazuecos, Jesús, Ruiz-Arroyo, José R., Garcia del Blanco, Bruno, Rumoso, José R.
• Format: Article
• Language: English
• Subjects: Blood Vessel Prosthesis; Drug-Eluting Stents; Everolimus - therapeutic use; Female; Humans; Infarto de miocardio; Male; Middle Aged; Myocardial infarction; Myocardial Infarction - surgery; Paclitaxel - therapeutic use; Propensity Score; Registries; Retrospective Studies; Stents liberadores de fármacos; Thrombectomy; Thrombectomy - methods; Treatment Outcome; Trombectomía
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/j.rec.2014.01.019

We sought to compare the long-term clinical outcome of with ST-segment elevation myocardial infarction treated with paclitaxel-eluting stents or everolimus-eluting stents and the influence of thrombectomy on outcomes. The ESTROFA-IM is a multicenter retrospective registry collecting consecutive patients with infarction treated with these stents in 16 centers. Propensity-score matching was performed to select comparable stent groups and comparable groups with and without thrombectomy. After matching patients, 350 treated with everolimus-eluting stents and 350 with paclitaxel-eluting stents were included in the analysis. The clinical and angiographic characteristics were comparable in both groups. The 2-year incidence of death, infarction, and target lesion revascularization was 14.9% for paclitaxel-eluting stents and 11.5% for everolimus-eluting stents (P = .04) and the incidence of definite/probable thrombosis 4.3% and 1.4%, respectively (P = .01). The use of paclitaxel-eluting was an independent predictor for events (hazard ratio = 2.44, 95% confidence interval, 1.28-4.65; P = .006). The benefit of everolimus-eluting stents over paclitaxel-eluting stents regarding stent thrombosis was more evident in the nonthrombectomy subgroup (5.4% vs 1.4%; P = .01). A significant interaction was found in the subgroups with and without thombectomy in the comparison between paclitaxel-eluting stents and everolimus-eluting stents for the end-point of stent thrombosis (P = .039). The results of this multicenter registry suggest better clinical outcomes with the everolimus-eluting stents in ST-segment elevation myocardial infarction. The lower risk of thrombosis with these stents could be more relevant in the absence of thrombectomy. Este estudio compara los resultados clínicos a largo plazo de pacientes tratados con stents liberadores de paclitaxel o de everolimus en el infarto agudo de miocardio con elevación del segmento ST, así como la influencia de la trombectomía. El ESTROFA-IM es un registro, en 16 centros, retrospectivo de pacientes consecutivos con infarto agudo de miocardio con elevación del segmento ST tratados con stents de paclitaxel o everolimus. Se realizó análisis de emparejamiento por propensión de tratamiento para seleccionar grupos comparables tanto para el modelo de stent como para uso de trombectomía. Después del emparejamiento, se incluyó en el análisis a 350 pacientes tratados con stents de paclitaxel y 350 con stents de everolimus. Las característic