Related Experiment Video
Updated: Feb 23, 2026
Ferromagnetic Bare Metal Stent for Endothelial Cell Capture and Retention
Published on: September 18, 2015
Bare metal versus drug eluting stents for ST-segment elevation myocardial infarction in the TOTAL trial
Shahar Lavi1, Javaid Iqbal2, John A Cairns3
1London Health Sciences Centre, Western University, London, ON, Canada.
Insights
Drug-eluting stents (DES) significantly improved cardiovascular outcomes, including death and heart attack, compared to bare-metal stents (BMS) in ST-elevation myocardial infarction (STEMI) patients. This supports DES use in primary PCI for STEMI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- The clinical benefit of drug-eluting stents (DES) in ST-elevation myocardial infarction (STEMI) requires further investigation.
- Current guidelines do not definitively establish the role of DES in primary percutaneous coronary intervention (PCI) for STEMI.
Purpose of the Study:
- To evaluate the safety and efficacy of DES versus bare-metal stents (BMS) in patients with STEMI.
- To compare cardiovascular outcomes between DES and BMS in a propensity-matched STEMI cohort.
Main Methods:
- A post-hoc analysis of the TOTAL trial was conducted.
- Propensity matching was used to create comparable cohorts of patients treated with DES or BMS.
- The study assessed a composite primary outcome and individual safety and efficacy endpoints.
Main Results:
- The composite outcome of cardiovascular death, recurrent MI, cardiogenic shock, or heart failure was significantly lower with DES (HR 0.67).
- DES use was associated with reduced rates of cardiovascular death, recurrent MI, target vessel revascularization, and stent thrombosis.
- No significant difference in major bleeding events was observed between DES and BMS groups.
Conclusions:
- Drug-eluting stents (DES) demonstrate improved cardiovascular outcomes compared to bare-metal stents (BMS) in STEMI patients.
- The findings support the routine use of DES during primary PCI for STEMI.
- Further research may explore long-term outcomes and specific DES technologies.
Background:
The safety and efficacy of drug eluting stents (DES) in the setting of ST elevation myocardial infarction (STEMI) is not well established.
Methods:
In the TOTAL trial, patients presenting with STEMI were randomized to routine thrombectomy versus PCI alone. In this post-hoc analysis, propensity matching was used to assess relative safety and efficacy according to type of stent used.
Results:
Each propensity-matched cohort included 2313 patients. The composite primary outcome of cardiovascular death, recurrent MI, cardiogenic shock or class IV heart failure within one year was lower in the DES group (HR 0.67; 95% CI 0.54 to 0.84, p=0.0004). Cardiovascular death (HR 0.61; 95% CI 0.43 to 0.86, p=0.005), recurrent MI (HR 0.51; 95% CI 0.35 to 0.75, p=0.0005), target vessel revascularization (HR 0.47; 95% CI 0.36 to 0.62, p<0.0001) and stent thrombosis (HR 0.60; 95% CI 0.40 to 0.89, p=0.01) were lower in the DES group. There was no difference in major bleeding between groups.
Conclusions:
In this observational analysis, the use of DES was associated with improvement in cardiovascular outcomes compared to the use of BMS. These results support the use of DES during primary PCI for STEMI.
More Related Videos
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
04:30A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies