Mortality following placement of drug-eluting and bare-metal stents for ST-segment elevation acute myocardial infarction in the Global Registry of Acute Coronary Events.

Abstract

AIMS:

To assess mortality after drug-eluting stent (DES) or bare-metal stent (BMS) for ST-segment elevation myocardial infarction (STEMI).

METHODS AND RESULTS:

In this multinational registry, 5093 STEMI patients received a stent: 1313 (26%) a DES and 3780 (74%) only BMS. Groups differed in baseline characteristics, type, or timing of percutaneous coronary intervention, with a higher baseline risk for patients receiving BMS. Two-year follow-up was available in 55 and 60% of the eligible BMS and DES patients, respectively. Unadjusted mortality was lower during hospitalization, similar for the first 6 months after discharge, and higher from 6 months to 2 years, for DES patients compared with that of BMS patients. Overall, unadjusted 2-year mortality was 5.3 vs. 3.9% for BMS vs. DES patients (P = 0.04). In propensity- and risk-adjusted survival analyses (Cox model), post-discharge mortality was not different up to 6 months (P = 0.21) or 1 year (P = 0.34). Late post-discharge mortality was higher in DES patients from 6 months to 2 years (HR 4.90, P = 0.01) or from 1 to 2 years (HR 7.06, P = 0.02). Similar results were observed when factoring in hospital mortality.

CONCLUSION:

The observation of increased late mortality with DES vs. BMS suggests that DES should probably be avoided in STEMI, until more long-term data become available.

• Authors: Ph Gabriel Steg, Keith A A Fox, Kim A Eagle, Mark Furman, Frans Van de Werf, Gilles Montalescot, Shaun G Goodman, Alvaro Avezum, Wei Huang, Joel M Gore, Global Registry of Acute Coronary Events (GRACE) Investigators
• Journal: European heart journal (Eur Heart J) Vol. 30 Issue 3 Pg. 321-9 (Feb 2009) ISSN: 1522-9645 [Electronic] England
• PMID: 19147604 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Angioplasty, Balloon, Coronary (instrumentation, mortality)
• Contraindications
• Drug-Eluting Stents (adverse effects, statistics & numerical data)
• Electrocardiography
• Epidemiologic Methods
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (mortality, physiopathology, therapy)
• Stents (adverse effects, statistics & numerical data)