Impact of myocardial infarction status on long-term outcomes after PCI with the ultimaster biodegradable-polymer sirolimus-eluting stent

Background Patients presenting with acute myocardial infarction (MI) represent a high-risk population after percutaneous coronary intervention (PCI), characterized by plaque instability, residual thrombus burden, and heightened ischemic and bleeding risk. However, the time-dependent risk profile and long-term durability of stent-related outcomes according to MI status have not been characterized for the Ultimaster TM biodegradable-polymer sirolimus-eluting stent (BP-SES). We evaluated clinical outcomes according to MI status using a 1-month landmark approach. Methods In this prospective, multicenter Korean registry, 932 patients who underwent PCI with the Ultimaster TM or Ultimaster TM Tansei TM BP-SES were stratified into MI ( n = 346) and non-MI ( n = 586) groups. The primary endpoint was net adverse clinical events (NACE), a composite of cardiac death, MI, cerebrovascular accident, bleeding, and definite or probable stent thrombosis, assessed at 1 month, at 1 year, and from 1 month to 3 years using a 1-month landmark analysis. Results At 1 month, NACE was significantly higher in the MI group [12.1% vs. 7.0%; hazard ratio [HR] 1.66, 95% confidence interval [CI] 1.01–2.72; p = 0.045], driven primarily by numerical excesses in cardiac death and bleeding. At 1 year, the cumulative incidence of NACE was numerically higher in the MI group (20.5% vs. 14.9%), a relative difference of approximately 40% without statistical significance, and 1-year target lesion failure was low and comparable (7.2% vs. 5.3%; p = 0.482). In the 1-month landmark analysis evaluating events from 1 month to 3 years, no significant differences were observed for any endpoint, including NACE (12.4% vs. 13.3%; HR 0.84, 95% CI 0.55–1.29; p = 0.425). Conclusion The early excess of clinical events in MI patients undergoing PCI with the Ultimaster TM BP-SES did not extend beyond the first month, and no significant differences in outcomes through 3 years were detected compared with non-MI patients. These findings suggest that, in the era of contemporary BP-SES and contemporary secondary prevention, MI status itself does not appear to be a major determinant of long-term outcomes after PCI, and are reassuring for the use of BP-SES across the spectrum of clinical presentations.