Drug Eluting Stents versus Bare Metal Stents in ST- Segment Elevation Myocardial Infarction

Abstract

Background: The aim of this study was to compare the effectiveness and safety of drug eluting stents (DES) with bare metal stents (BMS) in patients presented with ST- segment elevation myocardial infarction (STEMI) in a real world setting.

Methods: One thousand five hundred ninety six STEMI patients treated with primary percutaneous coronary intervention from January 2013 to March 2016 were enrolled to study. One thousand one hundred ninety four of them received BMS while 402 of them received DES. Patients were analyzed for major adverse cardiac events (MACE) and stent thrombosis (ST).   

Results: There was no difference at 30 days in relation of MACE, all cause death, re-MI, TVR, TLR and ST. The cumulative incidence of MACE was significantly higher in DES group (9,2% vs. 7,0%, p = 0.02) at 1 year. Stent thrombosis and re-MI incidence were significantly higher in DES group (4,2% vs. 2,6%, p = 0.028, 6,9% vs. 4,8%, p = 0.015) respectively at 1 year. There was no statistically significant difference in relation of all cause death, TVR and TLR at 1 year. The statistically differences between groups vanished at 2 year and the groups looked similar. Male gender (HR, 1.40; 95% CI, 1.00 to 1.94; p = 0.043) and presence of DM (HR, 1.73; 95% CI, 1.29 to 2.32; p<0,001) were found to be independent predictors of 2-year MACE.

Conclusion: Our study showed effectiveness and safety of DES in STEMI. Despite increased incidence of MACE, re-MI and ST in 1-year, DES was found to be non-inferior to BMS at 2-year follow up.

Keywords

• Drug-eluting stents,Bare-metal stents,ST elevation Myocardial Infarction

ST-Segment Yükselmeli Miyokard İnfarktüsünde Çıplak Metal Stentler ve İlaç kaplı Stentlerin Karşilaştırılması

Abstract

Amaç: Bu çalışmada ST segment elevasyonlu myokard enfarktüsünde ilaç kaplı stentleri ve çıplak metal stentleri karşılaştırmak istedik. 

Gereç ve Yöntem: Çalışmamıza merkezimize Ocak 2013 ve Mart 2016 tarihleri arasında başvuran toplam 1596 ST segment elevasyonlu myokard enfarktüsü alındı. Katılımcılar çıplak metal stent grubu (n=1194) ve ilaç kaplı stent grubu (n=402) olarak iki gruba ayrıldı. Hastalar major kardiyak sonlanım acısından değerlendirildi. 
Bulgular: Grublar arasında ilk 30 günde major kardiyak sonlanım ve tüm ölüm açısından fark olmamasına rağmen, toplam major kardiyak sonlanım insidansı (9,2% vs. 7,0%, p=0.02), stent thrombozu (4,2% vs. 2,6%, p=0.028) ve tekrar myokard enfarktüsü (6,9% vs. 4,8%, p=0.015) ilaç kaplı stent grubunda yüksek bulundu. Bununla birlikte toplam mortalitede, hedef damar ve lezyon revaskülarizasyonunda istatiksel anlamlı fark bulunmadı. Major kardiyak sonlanım ve toplam mortalite 2 yıllık takipte gruplar arasında benzer bulundu. Erkek cinsiyet (HR, 1.40; 95% CI, 1.00 to 1.94; p = 0.043) ve diyabet varlığı (HR, 1.73; 95% CI, 1.29 to 2.32; p<0,001) major kardiyak sonlanım için bağımsız prediktör olarak saptandı.
Sonuç: Sonuclarımız ilaç kaplı stentlerin çıplak metal stentler ile karşılaştırıldığında hem etkili hem de güvenli oldugunu gösterdi. 

Keywords

• Çıplak metal stent,ilaç kaplı stent,ST yükselmeli Myokard enfarktüsü

References

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9. 9. Stone, G. W., Grines, C. L., Cox, D. A., Garcia, E., Tcheng, J. E., Griffin, J. J., ... & Rutherford, B. D. Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. New England Journal of Medicine, 2002; 346: 957-66.
10. 10. Laarman GJ, Suttorp MJ, Dirksen MT, van Heerebeek L, Kiemeneij F, Slagboom T, van der Wieken LR, Tijssen JG, Rensing BJ, Patterson M. Paclitaxel-eluting versus uncoated stents in primary percutaneous coronary intervention. N Engl J Med. 2006;355:1105–13.
11. 11. Daemen J, Tanimoto S, García-García HM, Kukreja N, van de Sande M, Sianos G, de Jaegere PP, van Domburg RT, Serruys PW. Comparison of three-year clinical outcome of sirolimus- and paclitaxel-eluting stents versus bare metal stents in patients with ST-segment elevation myocardial infarction (from the RESEARCH and T-SEARCH Registries). Am J Cardiol. 2007;99:1027–32.
12. 12. De Luca, G., Stone, G. W., Suryapranata, H., Laarman, G. J., Menichelli, M., Kaiser, C., ... & Pittl, U. Efficacy and safety of drug-eluting stents in ST-segment elevation myocardial infarction: a meta-analysis of randomized trials. International journal of cardiology,2009;133: 213-22.
13. 13. Kastrati, A., Dibra, A., Spaulding, C., Laarman, G. J., Menichelli, M., Valgimigli, M., ... & Seyfarth, M. Meta-analysis of randomized trials on drug-eluting stents vs. bare-metal stents in patients with acute myocardial infarction. European heart journal, 2007; 28: 2706-13.
14. 14. Pasceri, V., Patti, G., Speciale, G., Pristipino, C., Richichi, G., & Di Sciascio, G. Meta-analysis of clinical trials on use of drug-eluting stents for treatment of acute myocardial infarction. American heart journal,2007; 153: 749-54.
15. 15. Stone, G. W., Lansky, A. J., Pocock, S. J., Gersh, B. J., Dangas, G., Wong, S. C., ... & Dudek, D. Paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction. New England Journal of Medicine, 2009; 360:1946-59.
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21. 21. Ault KA, Cannon CP, Mitchell J, McCahan J, Tracy RP, Novotny WF, Reimann JD, Braunwald E. Platelet activation in patients after an acute coronary syndrome: results from the TIMI-12 trial. Thrombolysis in myocardial infarction. J Am Coll Cardiol 1999;33:634–9.
22. 22. Inoue T, Sohma R, Miyazaki T, Iwasaki Y, Yaguchi I, Morooka S. Comparison of activation process of platelets and neutrophils after coronary stent implantation versus balloon angioplasty for stable angina pectoris. Am J Cardiol 2000;86:1057–62
23. 23. Luscher TF, Steffel J, Eberli FR, Joner M, Nakazawa G, Tanner FC, Virmani R. Drug-eluting stent and coronary thrombosis: biological mechanisms and clinical implications. Circulation 2007;115:1051–58.
24. 24. Rousan, T. A., Pappy, R. M., Chen, A. Y., Roe, M. T., & Saucedo, J. F. Impact of diabetes mellitus on clinical characteristics, management, and in-hospital outcomes in patients with acute myocardial infarction (from the NCDR). The American journal of cardiology, 2014; 114: 1136-44.