Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: 3-year follow-up of the randomized DEDICATION (Drug Elution and Distal Protection in Acute Myocardial Infarction) Trial.

Abstract

OBJECTIVES:

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

BACKGROUND:

The evidence of long-term efficacy and safety after implantation of DES in patients with complex lesions is scarce.

METHODS:

We randomly assigned 626 patients with STEMI referred within 12 h to have a DES or a BMS implanted in the infarct-related lesion with or without distal protection during primary percutaneous coronary intervention.

RESULTS:

At 3 years, target lesion revascularization was 6.1% in the DES group compared with 16.3% in the BMS group (p<0.001), and the rate of major adverse cardiac events was 11.5% versus 18.2%, respectively (p=0.02). Whereas all-cause mortality did not differ significantly, the rate of cardiac death was higher in the DES group, 6.1% versus 1.9% for the BMS group (p=0.01). The occurrence of reinfarction, stroke, and stent thrombosis was similar.

CONCLUSIONS:

Implantation of DES in patients with STEMI reduces the long-term rate of major adverse cardiac events compared with BMS, but patients with DES had a higher risk of cardiac death not attributed to myocardial infarction or stent thrombosis. (Drug Elution and Distal Protection During Percutaneous Coronary Intervention in ST Elevation Myocardial Infarction [DEDICATION]; NCT00192868)

• Authors: Anne Kaltoft, Henning Kelbaek, Leif Thuesen, Jens Flensted Lassen, Peter Clemmensen, Lene Kløvgaard, Thomas Engstrøm, Hans E Bøtker, Kari Saunamäki, Lars R Krusell, Erik Jørgensen, Hans-Henrik Tilsted, Evald H Christiansen, Jan Ravkilde, Lars Køber, Klaus F Kofoed, Christian J Terkelsen, Steffen Helqvist
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 56 Issue 8 Pg. 641-5 (Aug 17 2010) ISSN: 1558-3597 [Electronic] United States
• PMID: 20688033 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Angioplasty, Balloon
• Drug-Eluting Stents (adverse effects)
• Electrocardiography
• Female
• Follow-Up Studies
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Myocardial Infarction (mortality, physiopathology, therapy)
• Stents (adverse effects)
• Survival Rate
• Thrombosis (etiology)