September 4, 2008Circulation Cardiovascular Interventions
Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction
Key result
Drug-eluting stents did not reduce mortality or repeat revascularization versus bare metal stents in primary PCI, with a nonsignificant survival trend for sirolimus stents (HR 0.63; 95% CI 0.33-1.18).
Why the study?
Do drug-eluting stents reduce repeat revascularization or improve survival compared to bare metal stents in unselected patients undergoing primary percutaneous coronary intervention for acute myocardial infarction?
Population
1,738 unselected patients undergoing primary percutaneous coronary intervention for a de novo lesion in…
Comparison
Drug-eluting stents, specifically… vs Bare metal stents (BMS, n=531)
Design
Cohort
Follow-up
median 1185 days (interquartile range, 746 to 1675)
Authors
Discussion
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Implication
No clear benefit of DES over BMS seen in primary PCI; leaves open optimal stent strategy for AMI pending RCTs.
Study Design
Type
Cohort (n=1,738)
Multicenter
No
Structured PICO
Do drug-eluting stents reduce repeat revascularization or improve survival compared to bare metal stents in unselected patients undergoing primary percutaneous coronary intervention for acute myocardial infarction?
P
Population
1,738 unselected patients undergoing primary percutaneous coronary intervention for a de novo lesion, followed for a median of 1185 days.
E
Exposure
Drug-eluting stents (DES), specifically sirolimus-eluting stents (SES, n=185) or paclitaxel-eluting stents (PES, n=1022)
C
Comparator
Bare metal stents (BMS, n=531)
O
Outcome
All-cause mortality and repeat revascularizationhard clinical
Main Result
Hazard Ratio: 0.63 (95% CI 0.33–1.18)
In unselected patients undergoing PPCI for acute myocardial infarction, drug-eluting stents did not reduce repeat revascularizations compared to bare metal stents, and very late stent thrombosis was observed only in the DES groups.
Cite This Study
Kukreja et al. (2008) conducted a cohort in Acute Myocardial Infarction (n=1,738). Drug-eluting stents (sirolimus-eluting or paclitaxel-eluting) vs. Bare metal stents was evaluated on All-cause mortality (HR 0.63, 95% CI 0.33-1.18). Drug-eluting stents did not reduce mortality or repeat revascularization versus bare metal stents in primary PCI, with a nonsignificant survival trend for sirolimus stents (HR 0.63; 95% CI 0.33-1.18).