Drug-eluting stents showed no significant difference versus bare-metal stents for 1-year mortality or re-AMI in AMI complicated by cardiogenic shock (HR 0.83; 95% CI 0.64-1.06; p=0.14).
RCT (n=652)
Yes
Does the use of drug-eluting stents improve the composite of 1-year mortality or re-AMI compared to bare-metal stents in patients with acute myocardial infarction complicated by cardiogenic shock?
In patients with acute myocardial infarction complicated by cardiogenic shock, the use of drug-eluting stents compared to bare-metal stents resulted in similar 1-year rates of mortality or recurrent AMI.
Effect estimate: HR 0.83 (95% CI 0.64 to 1.06)
p-value: p=0.14
OBJECTIVES: The aim of the present study was to assess the outcome of patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) receiving drug-eluting stents (DES) compared with bare-metal stents (BMS). Data comparing these two stent technologies in AMI with CS were limited. METHODS: A total of 783 patients with AMI and CS undergoing early revascularisation were included in the randomised Intra-aortic Balloon Pump in Cardiogenic Shock II trial (n=600) and the associated registry (n=183). Patients receiving no stent or both, DES and BMS, were excluded. Primary end point was the composite of 1-year mortality or re-AMI. RESULTS: Of the total cohort, 652 (83%) patients received either solely DES or BMS and were included in the present analysis. Of these, 276 (42%) patients received DES and 376 (58%) received BMS. After adjustment for baseline characteristics, there was no significant difference between DES and BMS regarding the primary end point (HR 0.83 (CI 0.64 to 1.06); p=0.14). There was an independent association of BMS use with older age, atrial fibrillation and coronary single-vessel disease. DES use was associated with prior known dyslipidaemia, baseline haemoglobin level, anterior AMI and treatment at frequently enrolling centres. CONCLUSIONS: Despite the frequent use of DES nowadays, a substantial number of patients were treated by BMS in AMI complicated by CS. After adjustment for risk factors, the 1-year outcome of patients treated by DES compared with BMS was similar. TRIAL REGISTRATIONNUMBER: www.clinicaltrials.gov: NCT00491036.
Ledwoch et al. (Tue,) conducted a rct in Acute myocardial infarction complicated by cardiogenic shock (n=652). Drug-eluting stents (DES) vs. Bare-metal stents (BMS) was evaluated on Composite of 1-year mortality or re-AMI (HR 0.83, 95% CI 0.64 to 1.06, p=0.14). Drug-eluting stents showed no significant difference versus bare-metal stents for 1-year mortality or re-AMI in AMI complicated by cardiogenic shock (HR 0.83; 95% CI 0.64-1.06; p=0.14).