Effectiveness of Drug-Eluting Stents versus Bare-Metal Stents in Large Coronary Arteries in Patients with Acute Myocardial Infarction

다국어 초록 (Multilingual Abstract)

This study compared clinical outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in large coronary arteries in patients with acute myocardial infarction (MI). A total of 985 patients who underwent single-vessel percutaneous coronary intervention (PCI)in large coronary arteries (≥ 3.5 mm) in lesions < 25 mm were divided into DES group (n = 841) and BMS group (n = 144). Clinical outcomes during 12 months were compared.
In-hospital outcome was similar between the groups. At six months, death/MI rate was not different. However, DES group had significantly lower rates of target-lesion revascularization (TLR) (1.7% vs 5.6%, P = 0.021), target-vessel revascularization (TVR)(2.2% vs 5.6%, P = 0.032), and total major adverse cardiac events (MACE) (3.4% vs 11.9%, P = 0.025). At 12 months, the rates of TLR and TVR remained lower in the DES group (2.5% vs 5.9%, P = 0.032 and 5.9% vs 3.1%, P = 0.041), but the rates of death/MI and total MACE were not statistically different. The use of DES in large vessels in the setting of acute MI is associated with lower need for repeat revascularization compared to BMS without compromising the overall safety over the course of one-year follow-up.

참고문헌 (Reference)

1 Elezi S, "Vessel size and long-term outcome after coronary stent placement" 98 : 1875-1880, 1998

2 Brar SS, "Use of drug-eluting stents in acute myocardial infarction: a systematic review and meta-analysis" 53 : 1677-1689, 2009

3 Valgimigli M, "Two-year clinical followup after sirolimus-eluting versus bare-metal stent implantation assisted by systematic glycoprotein IIb/IIIa inhibitor infusion in patients with myocardial infarction: results from the STRATEGY study" 50 : 138-145, 2007

4 Spaulding C, "TYPHOON Investigators. Sirolimus-eluting versus uncoated stents in acute myocardial infarction" 355 : 1093-1104, 2006

5 Stone GW, "TAXUS- IV Investigators. One-year clinical results with slow-release, polymerbased, paclitaxel-eluting TAXUS stent: TAXUS-IV trial" 109 : 1942-1947, 2004

6 Stone GW, "TAXUS- IV Investigators. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease" 350 : 221-231, 2004

7 Dawkins KD, "TAXUS VI Investigators. Clinical efficacy of polymer-based paclitaxel- eluting stents in the treatment of complex, long coronary artery lesions from a multicenter, randomized trial: support for the use of drug-eluting stents in contemporary clinical practice" 112 : 3306-3313, 2005

8 Stone GW, "TAXUS V Investigators. Comparison of a polymer-based paclitaxel-eluting stent with a bare metal stent in patients with complex coronary artery disease: a randomized controlled trial" 294 : 1215-1223, 2005

9 Valgimigli M, "STRATEGY Investigators. Tirofiban and sirolimus-eluting stent vs. abciximab and bare-metal stent for acute myocardial infarction: a randomized trial" 293 : 2109-2117, 2005

10 Moses JW, "SIRIUS Investigators. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery" 349 : 1315-1323, 2003

11 Ardissino D, "SES-SMART Investigators. Sirolimus-eluting vs. uncoated stents for prevention of restenosis in small coronary arteries: a randomized trial" 292 : 2727-2734, 2004

12 Menichelli M, "Randomized trial of sirolimus-eluting stent versus bare-metal stent in acute myocardial infarction (SESAMI)" 49 : 1924-1930, 2007

13 Regar E, "RAVEL Study Group. Angiographic findings of the multicenter Randomized Study With the Sirolimus-Eluting Bx Velocity Balloon- Expandable Stent (RAVEL): sirolimus-eluting stents inhibit restenosis irrespective of the vessel size" 106 : 1949-1956, 2002

14 Schömig A, "Prevention of restenosis by systemic drug therapy: back to the future" 112 : 2759-2761, 2005

15 Kastrati A, "Predictive factors of restenosis after coronary stent placement" 30 : 1428-1436, 1997

16 Moses JW, "Outcomes with the paclitaxel- eluting stent in patients with acute coronary syndromes: analysis from the TAXUS-IV trial" 45 : 1165-1171, 2005

17 Di Lorenzo E, "Long-term outcome of drug-eluting stents compared with bare metal stents in ST-segment elevation myocardial infarction: results of the paclitaxel- or sirolimus-eluting stent versus bare metal stent in Primary Angioplasty (PASEO) Randomized Trial" 120 : 964-972, 2009

18 Agostoni P, "Is bare-metal stenting superior to balloon angioplasty for small vessel coronary artery disease? Evidence from a meta-analysis of randomized trials" 26 : 881-889, 2005

19 Stone GW, "HORIZONS-AMI Trial Investigators. Paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction" 360 : 1946-1959, 2009

20 조정선, "Effects of Combined Therapy with Ezetimibe Plus Simvastatin After Drug-Eluting Stent Implantation in a Porcine Coronary Restenosis Model" 대한의학회 25 (25): 716-722, 2010

21 Quizhpe AR, "Drug-eluting stents vs. bare metal stents for the treatment of large coronary vessels" 154 : 373-378, 2007

22 Anderson HV, "Drug-eluting stents for acute myocardial infarction" 49 : 1931-1933, 2007

23 Mauri L, "Drug-eluting or bare-metal stents for acute myocardial infarction" 359 : 1330-1342, 2008

24 심두선, "Differences in Clinical Outcomes Between Patients With ST-Elevation Versus Non-ST-Elevation Acute Myocardial Infarction in Korea" 대한심장학회 39 (39): 297-303, 2009

25 Kelbaek H, "DEDICATION Investigators. Drugeluting versus bare metal stents in patients with ST-segment-elevation myocardial infarction: eight-month follow-up in the Drug Elution and Distal Protection in Acute Myocardial Infarction (DEDICATION) trial" 118 : 1155-1162, 2008

26 Sim DS, "Current management of acute myocardial infarction: Experience from the Korea Acute Myocardial Infarction Registry" ELSEVIER IRELAND LTD 56 (56): 1-7, 2010

27 Hoffmann R, "Coronary in-stent restenosis - predictors, treatment and prevention" 21 : 1739-1749, 2000

28 Steinberg DH, "Comparison of effectiveness of bare metal stents versus drug-eluting stents in large (> or =3.5 mm) coronary arteries" 99 : 599-602, 2007

29 Na JO, "Bare-metal stents versus drug-eluting stents in large (≥ 3.5 mm) single coronary artery: Angiographic and clinical outcomes at 6 months" 54 : 108-114, 2009

30 Pfisterer M, "BASKET. Long-term benefit-risk balance of drug-eluting vs. bare-metal stents in daily practice: does stent diameter matter? Three-year follow-up of BASKET" 30 : 16-24, 2009