Why the study?
Does a drug-eluting stent reduce late lumen loss compared to a bare metal stent in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention?
Does a drug-eluting stent reduce late lumen loss compared to a bare metal stent in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention?
In patients with STEMI, DES implantation significantly reduced late lumen loss and the need for repeat revascularization compared to bare metal stents, though with a non-significant trend toward increased cardiac death.
DES lowers late lumen loss versus BMS in STEMI primary PCI; confirms angiographic superiority of drug elution in acute coronary syndromes.
BACKGROUND: Implantation of drug-eluting stents (DES) limits the rate of coronary restenosis in most patients with coronary artery disease, but data are scarce with regard to their use in patients with ST-segment-elevation myocardial infarction and in connection with distal protection of the microvascular perfusion during primary percutaneous coronary intervention. METHODS AND RESULTS: We randomly assigned 626 patients referred within 12 hours from symptom onset of an ST-elevation myocardial infarction to have a DES or a bare metal stent implanted in the infarct-related lesion with or without distal protection during primary percutaneous coronary intervention. Quantitative coronary angiography was performed during the index treatment and 8 months later. The primary end point was loss of the lumen diameter in the infarct-related lesion induced by neointimal proliferation. Patients were comparable with regard to baseline demographic and angiographic characteristics. The mean late lumen loss was significantly lower in patients treated with a DES (0.06 mm; SD, 0.66 mm) than in patients who had a bare metal stent implanted (0.47 mm; SD, 0.69 mm; P<0.001). The rate of the composite end point of cardiac death, recurrent myocardial infarction, and target lesion revascularization was 8.6% in the DES group versus 14.4% in the bare metal stent group (P=0.03). Cardiac death occurred in 4.2% and 1.6% of the patients (P=0.09) and stent thrombosis occurred in 2.0% and 2.6% (P=0.72), respectively. CONCLUSIONS: Implantation of DES improves the angiographic outcome and need for repeat revascularization without increasing the short-term risk of stent thrombosis but has a tendency to increase cardiac death in patients with ST-segment-elevation myocardial infarction.
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Kelbæk et al. (2008) studied this question.
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