Long-term safety and effectiveness of drug-eluting stents compared to bare metal stents in ST elevation myocardial infarction: findings from the guthrie health off-label stent (ghost) registry

Journal of Interventional Cardiology, 05/07/2012

In this study of ST–segment elevation myocardial infarction (STEMI) patients, drug–eluting stents (DES) implantation was safer than bare metal stent (BMS) implantation and was associated with lower major adverse cardiac event (MACE) at long–term follow–up.

Methods

  • Authors studied 554 STEMI patients who underwent successful PCI with either DES or bare metal stent (BMS).
  • Primary study end–points were time to occurrence of ST and the composite of death or myocardial infarction (MI).
  • Secondary end–points were time to occurrence of major adverse cardiac events (MACEs) and discrete events that comprise MACE (death, MI, and target vessel revascularization [TVR]).
  • Outcomes of the DES and BMS groups were assessed by survival analysis and multivariable Cox regression.

Results

  • There were 205 (37%) patients who received DES and 349 (63%) patients who received BMS.
  • At a median follow–up of 41.4 months after PCI, there were no differences in the unadjusted incidence of ST (ST, 3.4 vs. 4.3%, log–rank P = 0.61) and MI (6.8% vs. 8%, P = 0.61) between DES versus BMS groups, respectively.
  • However, DES implantation was associated with lower unadjusted incidence of death or MI (11% vs. 23.5%, P = 0.0002), MACE (16% vs. 34%, P < 0.0001), death (6.3% vs. 17%, P = 0.0004), and TVR (9.8% vs. 18%, P = 0.008) than BMS implantation.
  • In multivariable analyses, DES implantation was associated with significantly lower incidence of MACE (adjusted HR = 0.47 [95% CI: 0.31–0.76], P = 0.0007) than BMS implantation.

Print Article Summary Cat 2 CME Report