European Heart Journal Advance Access originally published online on January 15, 2009
European Heart Journal 2009 30(3):321-329; doi:10.1093/eurheartj/ehn604
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Mortality following placement of drug-eluting and bare-metal stents for ST-segment elevation acute myocardial infarction in the Global Registry of Acute Coronary Events
1 INSERM U-698 ‘Recherche Clinique en Athérothrombose’, Université Paris VII—Denis Diderot, Assistance Publique—Hôpitaux de Paris, Centre Hospitalier Bichat-Claude Bernard, 46 rue Henri Huchard, 75877 Paris Cedex 18, France
2 Cardiovascular Research, Division of Medical and Radiological Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
3 University of Michigan Cardiovascular Center, Ann Arbor, MI, USA
4 University of Massachusetts Medical School, Worcester, MA, USA
5 Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium
6 Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France
7 Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ont., Canada
8 Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
Received 17 July 2008; revised 25 October 2008; accepted 16 December 2008; online publish-ahead-of-print 15 January 2009.
* Corresponding author. Tel: +33 140258668, Fax: +33 140258865, Email: gabriel.steg{at}bch.aphp.fr
Aims: To assess mortality after drug-eluting stent (DES) or bare-metal stent (BMS) for ST-segment elevation myocardial infarction (STEMI).
Methods and results: In this multinational registry, 5093 STEMI patients received a stent: 1313 (26%) a DES and 3780 (74%) only BMS. Groups differed in baseline characteristics, type, or timing of percutaneous coronary intervention, with a higher baseline risk for patients receiving BMS. Two-year follow-up was available in 55 and 60% of the eligible BMS and DES patients, respectively. Unadjusted mortality was lower during hospitalization, similar for the first 6 months after discharge, and higher from 6 months to 2 years, for DES patients compared with that of BMS patients. Overall, unadjusted 2-year mortality was 5.3 vs. 3.9% for BMS vs. DES patients (P = 0.04). In propensity- and risk-adjusted survival analyses (Cox model), post-discharge mortality was not different up to 6 months (P = 0.21) or 1 year (P = 0.34). Late post-discharge mortality was higher in DES patients from 6 months to 2 years (HR 4.90, P = 0.01) or from 1 to 2 years (HR 7.06, P = 0.02). Similar results were observed when factoring in hospital mortality.
Conclusion: The observation of increased late mortality with DES vs. BMS suggests that DES should probably be avoided in STEMI, until more long-term data become available.
Key Words: Risk score • STEMI • Drug-eluting stent • Bare-metal stent
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