Long-term efficacy and safety outcomes after unrestricted use of drug-eluting stents in patients with acute coronary syndrome: mortality and major bleeding in a single-center registry.

Abstract

BACKGROUND:

Recent randomized clinical trials have reported favorable clinical outcomes after the use of drug-eluting stents (DES) in patients with acute coronary syndrome (ACS). However, the long-term efficacy and safety outcomes, bleeding outcome in particular, after DES implantation in ACS patients have not been thoroughly evaluated in a real-world population.

METHODS AND RESULTS:

We evaluated long-term clinical outcomes in 565 consecutive ACS patients who underwent DES implantation in an emergency setting between 2004 and 2011 (ST-segment elevation acute myocardial infarction [STEMI]: n=269, non-STEMI/unstable angina pectoris: n=296). Mean clinical follow-up period in this study was 4.6±2.0 years. The cumulative incidence of all-cause death, cardiac death, myocardial infarction, stent thrombosis and target-lesion revascularization was 6.9%, 4.0%, 2.2%, 1.3% and 8.4% at 1 year, and 19.6%, 6.7%, 5.6%, 3.0% and 13.9% at 5 years, respectively. The cumulative 5-year incidence of major bleeding events was 8.4% (n=42). Fatal bleeding events, however, occurred in only 4 patients, even including 2 patients who required resuscitation upon arrival at the hospital. Of the 42 patients with major bleeding events, 39 were taking dual antiplatelet therapy (DAPT) at the time of bleeding.

CONCLUSIONS:

DES implantation provided favorable long-term clinical outcomes with an acceptably low incidence of fatal bleeding in a real-world population of ACS patients. However, prolonged DAPT seems to be associated with major bleeding after DES implantation.

• Authors: Tetsuma Kawaji, Hiroki Shiomi, Takeshi Morimoto, Toshihiro Tamura, Ryusuke Nishikawa, Mariko Yano, Junichi Tazaki, Masao Imai, Naritatsu Saito, Takeru Makiyama, Satoshi Shizuta, Koh Ono, Takeshi Kimura
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 78 Issue 7 Pg. 1628-35 ( 2014) ISSN: 1347-4820 [Electronic] Japan
• PMID: 24828916 (Publication Type: Clinical Trial, Journal Article)

Topics

• Acute Coronary Syndrome (mortality, surgery)
• Aged
• Aged, 80 and over
• Disease-Free Survival
• Drug-Eluting Stents (adverse effects)
• Female
• Follow-Up Studies
• Hemorrhage (etiology, mortality)
• Humans
• Male
• Middle Aged
• Myocardial Infarction (etiology, mortality)
• Registries
• Survival Rate