Key result
Paclitaxel DES shows no benefit over BMS for MACE in acute STEMI.
Why the study?
Data comparing efficacy and safety of paclitaxel drug-eluting stents versus bare metal stents in acute STEMI are limited and inconclusive.
Does paclitaxel DES reduce major adverse cardiac events compared to BMS in patients with acute STEMI?
Cohort (n=143)
No
Does paclitaxel DES reduce major adverse cardiac events compared to BMS in patients with acute STEMI?
Absolute Event Rate: 10% vs 13%
p-value: p=0.65
In patients with acute STEMI, paclitaxel DES did not significantly reduce overall major adverse cardiac events compared to BMS at 6 months, but did eliminate the need for target vessel revascularization.
Paclitaxel DES showed no MACE benefit over BMS in STEMI; leaves open whether DES reduces revascularization without increasing risk in larger cohorts.
INTRODUCTION: Data comparing efficacy and safety of drug eluting stents (DES), particularly paclitaxel stent with bare metal stents (BMS) in the setting of acute ST elevation myocardial infarction (STEMI) is limited and inconclusive. The aim of our study is to compare the efficacy and safety of paclitaxel stent with bare metal stent in acute STEMI. METHODS: A retrospective cohort study was performed on patients from our single community hospital who participated in the C-PORT trial from January 2003 to May 2005. One hundred forty-three patients treated exclusively with either BMS or paclitaxel DES were included (79 with paclitaxel DES and 64 with BMS) and were followed at 1, 3, and 6 months. The primary outcome was occurrence of major adverse cardiac events defined as cardiac death, STEMI or NSTEMI or the need for target vessel revascularization. Variables were compared using appropriate statistics and event free survival curves were estimated. RESULTS: Baseline clinical characteristics in BMS and paclitaxel DES groups were well matched. No statistical difference between BMS and DES groups in the rate of cardiac death (6% vs. 9%, P = 0.56), STEMI or NSEMI (1.6% vs. 1.3% respectively, P = 0.88) and composite end point (13% vs. 10%, P = 0.65) was observed while a significant reduction in target vessel revascularization was seen in DES group (6% vs. 0% respectively, P = 0.02) was noticed. CONCLUSION: In our patient group with acute STEMI, the use of paclitaxel DES did not show significant decrease in cumulative end points, cardiac mortality and recurrent STEMI or NSTEMI compared with BMS over a 6-month follow-up period. However, a significant reduction in revascularization of target vessel was seen.
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Hamirani et al. (2008) conducted a cohort in Acute ST elevation myocardial infarction (STEMI) (n=143). Paclitaxel drug-eluting stent vs. Bare-metal stent was evaluated on Major adverse cardiac events (cardiac death, STEMI or NSTEMI, or need for target vessel revascularization) (p=0.65). In patients with acute STEMI, paclitaxel drug-eluting stents did not significantly reduce major adverse cardiac events compared to bare-metal stents (10% vs 13%, P=0.65) over 6 months.
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