Drug-eluting versus bare-metal stents in the treatment of patients with ST-segment elevation myocardial infarction.

OBJECTIVES

The purpose of this study was to compare outcomes for drug-eluting stents (DES) and bare-metal stents (BMS) for patients with ST-segment elevation myocardial infarction (STEMI).

BACKGROUND

Despite some controversy related to late stent thromboses, DES are approved for use in many patients undergoing stenting. However, there are several types of patients in whom implanting a DES would be regarded as off-label use, and this study compares DES and BMS for one of these groups.

METHODS

New York's percutaneous coronary intervention registry was used to identify 772 patients undergoing percutaneous coronary intervention (PCI) for STEMI who received BMS and 1,154 STEMI patients who received DES between October 1, 2003, and December 31, 2004. These patients were tracked through December 31, 2005. Mortality, target vessel PCI, and subsequent coronary artery bypass graft (CABG) surgery within 2 years of undergoing the procedure were captured. Adverse outcomes were adjusted using proportional hazards methods to account for baseline differences in patients' severity of illness.

RESULTS

The BMS patients had significantly higher mortality (adjusted hazard ratio [HR] vs. DES = 2.01, 95% confidence interval [CI] 1.21 to 3.34, risk-adjusted mortality = 8.6% vs. 5.0%, p = 0.007) and significantly higher subsequent CABG surgery (adjusted HR vs. DES = 2.33, 95% CI 1.31 to 4.16, risk-adjusted rate = 6.4% vs. 3.0%, p = 0.004) rates. There was no difference by type of DES (adjusted HR for paclitaxel-eluting stent versus sirolimus-eluting stent; mortality 0.72, 95% CI 0.30 to 1.72), subsequent CABG surgery (adjusted HR = 0.60, 95% CI 0.26 to 1.40), and target vessel PCI (adjusted HR = 0.74, 95% CI 0.35 to 1.58).

CONCLUSIONS

In this observational study, DES were associated with lower mortality and subsequent CABG surgery when used for STEMI patients.