A Comparison of Bare Metal and Drug-Eluting Stents in Patients with Acute ST-Segment Elevation Myocardial Infarction

Study of:

Background:
Drug-eluting stents (DES) reduce in-stent restenosis in patients undergoing elective percutaneous coronary intervention (PCI). Limited data are available regarding DES for ST-segment elevation myocardial infarction (STEMI) despite widespread clinical use. Therefore, we evaluated the occurrence of major adverse cardiac events (MACE) among patients with STEMI who received paclitaxel-eluting (PES), sirolimus-eluting (SES) or bare metal stents (BMS).

Methods:
We measured the clinical characteristics, acute and long term outcomes in 472 consecutive STEMI patients who received direct PCI with either a BMS (n=124), PES (n=202) or SES (n=146). Patients were then followed for death, subacute thrombosis, nonfatal reinfarction, target vessel revascularization (TVR) and combined MACE.

Results:
The in-hospital mortality and 30-day results are summarized in Table 1. Additional MACE events have occurred with 19 BMS, 5 SES and 5 PES to date in patients with 6 month follow up. Patients with BMS were older but otherwise not different from patients with DES.

Conclusion:
DES are safe and effective when compared to BMS in the setting of STEMI. Early 6 month data suggest a decrease in MACE with DES that is similar to outcomes in other clinical settings. There appears to be no significant difference in outcomes between patients treated with either PES or SES. Six month follow up is in process and will be complete for >400 patients by November 2005.

Timothy D. Henry, MD, FACC

Daniel Lips, MD, FACC

Michael R. Mooney, MD, FACC

Jay H. Traverse, MD, FACC, FAHA

For more information about this study or other research studies at the Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, please contact Katie Menssen at 612-775-3052.