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Stent thrombosis up to 3 years after stenting for ST-segment elevation myocardial infarction versus for stable angina--comparison of the effects of drug-eluting versus bare-metal stents

Leibundgut, Gregor and Nietlispach, Fabian and Pittl, Undine and Brunner-La Rocca, Hanspeter and Kaiser, Christoph A. and Pfisterer, Matthias E.. (2009) Stent thrombosis up to 3 years after stenting for ST-segment elevation myocardial infarction versus for stable angina--comparison of the effects of drug-eluting versus bare-metal stents. American heart journal : an international publication for the study of the circulation, Vol. 158. pp. 271-276.

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Official URL: http://edoc.unibas.ch/dok/A6005011

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Abstract

BACKGROUND: The long-term safety of drug-eluting stents (DES) for the treatment of ST-segment elevation myocardial infarction (STEMI) is unclear and may differ from that in stable angina (stable) patients as noted in autopsy studies. METHODS: To assess this problem, 210 consecutive STEMI and 323 stable patients, randomized 2:1 to DES versus bare-metal stents (BMS), were followed up for 3 years for definite/probable stent thrombosis (ST) and cardiac death/myocardial infarction. Events occurring during the initial 6 months were separated from later events. RESULTS: The 3-year rate of ST was 8.1% in STEMI vs 3.4% in stable patients (P = .02), with corresponding rates of 9.4% vs 2.9% (P = .01) for DES and of 5.6% vs 4.3% (P = .71) for BMS patients, respectively. This difference appeared only after 6 months: 4.6% in STEMI vs 1.7% in stable patients (P = .05) and in DES-treated patients (6.2% vs 2.0%, P = .05). Results of ST were paralleled by findings of clinical events, although here differences were less pronounced, but also seen only late after stenting. Thus, in STEMI patients, late events occurred more frequently after DES vs BMS implantation (11.6% vs 3.0%, P = .04), compared to results in stable patients (DES 6.4%, BMS 1.9%, P = .08). CONCLUSIONS: In this pilot study, we observed an increased rate of late ST and a trend to more related clinical events in patients after stenting for STEMI vs for stable angina, particularly if treated with DES. This may explain outcome differences between results of pivotal trials in stable patients vs those of "real-world" patients.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Ehemalige Einheiten Medizinische Fächer (Klinik) > Kardiologie (Pfisterer)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Ehemalige Einheiten Medizinische Fächer (Klinik) > Kardiologie (Pfisterer)
UniBasel Contributors:Pfisterer, Matthias E. and Kaiser, Christoph A.
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:C.V. Mosby
ISSN:0002-8703
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:01 Mar 2013 11:14
Deposited On:01 Mar 2013 11:10

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