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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Clinical outcomes of drug-eluting stent use in patients with ST elevation myocardial infarction
R Gurvitch1, J Lefkovits, R J Warren
1Department of Cardiology, Royal Melbourne Hospital, Monash Center for Cardiovascular Research & Education in Therapeutics, Monash University, Melbourne, Australia.
Insights
In ST-elevation myocardial infarction (STEMI), drug-eluting stents (DES) showed similar outcomes to bare-metal stents (BMS) in a real-world study. High-risk patients treated with DES did not experience increased mortality or stent thrombosis compared to BMS.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Randomized trials on drug-eluting stents (DES) for ST-elevation myocardial infarction (STEMI) have yielded inconsistent results.
- Previous studies often excluded high-risk patients, limiting real-world applicability.
- Bare-metal stents (BMS) have been the traditional treatment for STEMI.
Purpose of the Study:
- To evaluate the real-world clinical outcomes of DES compared to BMS in STEMI patients.
- To assess the safety and efficacy of DES in a high-risk, unselected STEMI population.
- To identify predictors of adverse outcomes in STEMI patients treated with PCI.
Main Methods:
- A prospective observational study of 564 consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI).
- DES use was at operator discretion, primarily for high-risk patients (diabetes, long lesions, small vessels).
- Comparison of 12-month clinical outcomes between DES and BMS groups, including mortality, MACE, and TVR.
Main Results:
- DES were used in 45% of STEMI patients, predominantly in high-risk individuals.
- In-hospital and 12-month outcomes (death, MACE, stent thrombosis, TVR) were similar between DES and BMS groups.
- Cardiogenic shock and small reference vessel diameter (≤2.5 mm) were independent predictors of adverse outcomes.
Conclusions:
- Drug-eluting stents are utilized in a significant proportion of high-risk STEMI patients in Australia.
- DES use in this high-risk cohort did not lead to increased mortality, reinfarction, or stent thrombosis compared to BMS.
- Outcomes were primarily influenced by patient presentation (cardiogenic shock) and lesion characteristics, not stent type.
Aim:
Randomised trials using drug-eluting stents (DES) in ST elevation myocardial infarction (STEMI) have shown mixed results, and excluded patients at the highest risk of adverse outcomes. We aimed to determine the real world clinical outcomes of DES and compare these with bare-metal stents (BMS) in an unrestricted observational study of patients presenting with STEMI.
Methods:
564 consecutive patients undergoing primary PCI for STEMI were prospectively enrolled in the Melbourne Interventional Group registry (August 2004 to May 2006). The choice of using DES was at the operator's discretion, yet restricted to patients considered at highest risk of restenosis [e.g. diabetes, long lesions (>20 mm) and small target vessels (<2.5 mm)]. Clinical, procedural, and 12-month outcomes of patients receiving DES were evaluated and compared to BMS.
Results:
DES were used in 45% of patients presenting with STEMI. The rates of cardiogenic shock were similar in the DES and BMS groups (10.2 vs. 11%, p=0.71). In-hospital outcomes were not significantly different with respect to death (4.7 vs. 7.2%, p=0.23), major adverse cardiac events (MACE) (10.6 vs. 11.3%, p=0.80) or stent thrombosis (1.7 vs. 0.3%, p=0.71). At 12 months, target vessel revascularisation (TVR) in patients with DES was 10.2% vs. 7.2% in BMS (p=0.22). On propensity score adjusted multivariate analyses, the only independent predictor of 12-month MACE was presentation with cardiogenic shock (OR 2.59, 95% C.I 1.04-6.45), and the only predictor of 12-month TVR was reference vessel diameter ≤2.5 mm (OR 2.16, 95% C.I 1.06-4.33). DES use was not independently predictive of lower TVR, MACE rates or mortality. Late stent thrombosis rates were similar (DES 3.2 vs. BMS 3.8%, p=0.65).
Conclusions:
Drug-eluting stents are frequently used in Australia in the high-risk setting of STEMI. While target vessel revascularisation rates were moderate in this high-risk group, there was no increased mortality, reinfarction or stent thrombosis compared to bare-metal stents.
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