Major Adverse Cardiac Events at Follow-Up After Bare-Metal Stenting Versus Drug-Eluting Stenting in ST-Elevated Myocardial Infarction

• Published in: The American journal of cardiology 2009-06, Vol.103 (12), p.1672-1674
• Main Authors: Pierre-Louis, Bredy, MD, Aronow, Wilbert S., MD, Palaniswamy, Chandrasekar, MD, Singh, Tarunjit, MD, Ahn, Chul, PhD, Asija, Amit, MD, Weiss, Melvin B., MD, Kalapatapu, Kumar, MD, Pucillo, Anthony L., MD, Monsen, Craig E., MD
• Format: Article
• Language: English
• Subjects: Angioplasty, Balloon, Coronary - methods; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Coronary heart disease; Diseases of the cardiovascular system; Drug-Eluting Stents; Effects; Electrocardiography; Female; Follow-Up Studies; Graft Occlusion, Vascular - epidemiology; Graft Occlusion, Vascular - etiology; Heart; Heart attacks; Heart surgery; Humans; Incidence; Intervention; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - surgery; Myocarditis. Cardiomyopathies; New York - epidemiology; Prognosis; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Regression analysis; Risk Factors; Stents; Survival Rate - trends; Thrombolytic drugs; Time Factors
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2009.02.016

After thrombolytic therapy with tenecteplase for ST-segment elevation acute myocardial infarction, 376 patients were transferred from their hospital to Westchester Medical Center for percutaneous coronary intervention with stenting. Of 376 patients, 102 (27%) received bare-metal stents and 274 (73%) received drug-eluting stents with sirolimus-eluting or paclitaxel-eluting stents. At 43 months of follow-up, major adverse cardiac events occurred in 25 (25%) of 102 patients treated with bare-metal stents versus 40 (15%) of 274 patients treated with drug-eluting stents (p = 0.024). Cox regression analysis showed that significant independent prognostic factors for major adverse cardiac events were previous coronary artery bypass surgery (hazard ratio 2.2, p = 0.019), width of stent (hazard ratio 0.44, p = 0.006), and bare-metal stent (hazard ratio 1.8, p = 0.019). In conclusion, patients with bare-metal stents had a 1.8 times greater risk of developing major adverse cardiac events than did those using drug-eluting stents after controlling the confounding effects of previous coronary artery bypass surgery and stent width.