Clinical Safety of Drug-Eluting Stents in the Korea Acute Myocardial Infarction Registry

Lee, Sang Rok; Jeong, Myung Ho; Chae, Shung Chull; Hur, Seung Ho; Kim, Young Jo; Seong, In Whan; Chae, Jei Keon; Hong, Taek Jong; Rhew, Jae Young; Cho, Myeong Chan; Bae, Jang Ho; Rha, Seung Woon; Kim, Chong Jin; Jang, Yang Soo; Park, Seung Jung

doi:10.1253/circj.72.392

Cited by 41 publications

(26 citation statements)

References 30 publications

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“…The registry receives data from 41 primary percutaneous coronary intervention (PCI) centers in Korea. 16, 17 Between January and December of 2006, 5,421 patients were included and after exclusion of 848 patients who were younger than 20 years, who had visited the hospital more than 24 h after the onset of symptoms, or whose time of symptom onset or time of arrival to the first hospital was unclear, 4,573 patients were finally included in this study. The diagnosis of AMI was based on the clinical presentation, ECG findings and levels of cardiac enzymes.…”

Section: Methodsmentioning

confidence: 99%

Periodic Variation and Its Effect on Management and Prognosis of Korean Patients With Acute Myocardial Infarction

Park

Koo

Lee

et al. 2010

Circ J

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Background:The characteristics of the periodic variation in acute myocardial infarction (AMI) and the subsequent effect on management and prognosis have not been fully investigated in a large number of Asian populations. Methods and Results:From a prospective, observational multicenter online registry, 4,573 patients diagnosed as AMI in Korea from January to December 2006 were included. The highest incidence of AMI was between 8 a.m. and noon. The number of cases was highest in the winter and lowest in the autumn (13.6 vs 11.4 patients per day, P<0.001). Patients with symptom onset during working hours had a shorter time to first medical contact (203±288 min) compared with out-of-hours onset (230±288 min, P=0.003). In patients who underwent primary angioplasty, out-of hours symptom onset was associated with a greater time delay in both the patient's and the medical facility's response (door-to-balloon time out-of hours vs working hours: 101±54 min vs 84±44 min, P<0.001). In patients with ST-segment elevation myocardial infarction, symptoms to first medical contact showed a significant relationship to in-hospital mortality (for every 10 min of symptoms to first medical contact, odds ratio 1.006, 95% confidence interval 1.001-1.012, P=0.018) Conclusions: Circadian and periodic variation in AMI exists in Korean patients, which resulted in different patient behavior, hospital management and outcomes. (Circ J 2010; 74: 970 - 976)

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Section: Methodsmentioning

confidence: 99%

Periodic Variation and Its Effect on Management and Prognosis of Korean Patients With Acute Myocardial Infarction

Park

Koo

Lee

et al. 2010

Circ J

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“…The P value of the cumulative incidence of the composite of MACE comparing SES with BMS was 0.016 at 1 year, 0.036 at 2-years, and 0.06 at 3-year follow-up. KAMIR, 14,15,[21][22][23][24][25] launched in November 2005, is a population-based multicenter online data collection registry designed to reflect real-world practice in Asian patients presenting with AMI. The registry includes 50 community and teaching hospitals that enroll > 10,000 patients annually.…”

Section: Discussionmentioning

confidence: 99%

Are Drug-Eluting Stents Safer and More Effective Than Bare-Metal Stents in Patients With Acute Myocardial Infarction? 3-Year Follow-Up

et al. 2011

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SummaryQuestions about the long-term safety over the beneficial effects of drug-eluting stents (DES) have grown. We compared the long-term safety and efficacy of DES and bare-metal stents (BMS) in patients with acute myocardial infarction (AMI). A total of 1,017 AMI patients treated with stent implantation were followed for 3 years; 660 (64.9%) patients were treated with at least one DES and 357 (35.1%) patients were treated with at least one BMS. The primary endpoints were total mortality and the composite of major adverse cardiac events (MACE) including total mortality, re-MI, target lesion revascularization (TLR), and coronary artery bypass graft. At 3-years, the overall risks of cardiac and all-cause mortality were not different between the groups. However, the use of DES significantly decreased TLR (17.4% versus 7.1%, adjusted hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.30 to 0.65) and the composite of MACEs (27.2% versus 19.5%, adjusted HR 0.65, 95% CI 0.48 to 0.87) with no differences in MI. The risk of MACE up to 1 year (HR 0.56, 95% CI 0.39 to 0.80) was higher in BMS patients, whereas from 1 year to 2 years (HR 0.55, 95% CI 0.27 to 1.10) and from 2 years to 3 years (HR 1.13, 95% CI 0.56 to 2.28), it was similar between the groups. The use of DES does not have a significant effect on overall long-term clinical survival compared with that of BMS in AMI patients. However, the use of DES reduced the need for re-intervention and the risk of MACE, mostly within 1 year. (Int Heart J 2011; 52: 78-83)Key words: Acute myocardial infarction, Drug-eluting stent, Bare-metal stent D rug-eluting stents (DES) have caused drastic changes in interventional cardiology. Their use is associated with a reduction of neointimal hyperplasia, decreased risk of restenosis, and less frequent revascularization compared with bare-metal stents (BMS).1-4) However, questions about the long-term safety over the beneficial effects of DES have grown regarding the actual usefulness of DES because of the possible increased incidence of thrombosis and deaths compared with BMS during clinical follow-up. [5][6][7][8] Two recent randomized trials demonstrated that there was no significant difference between DES and BMS in terms of long-term survival, survival free of myocardial infarction (MI), and stent thrombosis. 9,10) One study even observed increased late mortality with DES versus BMS. 11)We compared all-cause death and the composite of major adverse cardiac events (MACE) including all-cause death, re-MI, target lesion revascularization (TLR), and coronary artery bypass graft (CABG) after implantation of DES and BMS. MethodsStudy population: The study population consisted of a total of 2,705 patients enrolled in the acute coronary syndrome registry who underwent percutaneous coronary intervention (PCI) at the Heart Center of Chonnam National University Hospital, South Korea between January 2004 and July 2006. A total of 1,237 patients had a final diagnosis of acute MI (AMI) and underwent primary PCI (PCI performed within 24 hour...

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“…15 In South Korea, recent studies also showed that DES implantation in patients with AMI was clinically safe and that SES implantation in AMI patients was associated with a reduction of angiographic restenosis at 6 months compared with PES. 11,12 However, there are few studies comparing SES, PES, and ZES in AMI patients. In the present study, the mid-term angiographic outcomes of ZES appeared similar to those for PES (similar follow-up MLD, percent restenosis and late loss), except for the similar incidence of binary restenosis and greater late loss when compared with the SES group ( Table 3).…”

Section: Circulation Journal Vol73 December 2009mentioning

confidence: 99%

“…[8][9][10] However, recently the KAMIR (Korea AMI Registry) study group reported that the use of DESs in Korean patients with AMI was clinically safe and effective. 11 There is very limited information regarding the angiographic and clinical outcomes among the different DESs in patients with AMI undergoing PCI, especially DESs other than SES and PES. Park et al showed that SES implantation in AMI patients was associated with a reduction of angiographic restenosis at 6 months compared with PES.…”

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confidence: 99%

Lack of Clinical Benefit of Improved Angiographic Results With Sirolimus-Eluting Stents Compared With Paclitaxel and Zotarolimus-Eluting Stents in Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Choi

Rha

Chen

et al. 2009

Circ J

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rug-eluting stents (DESs) have been rapidly accepted in real world clinical practice by the interventional community, largely being used in percutaneous coronary interventions (PCI). 1 Previous randomized trials have reported that the first generation DESs, including sirolimus-eluting stents (SES; Cypher™) and paclitaxel-eluting stents (PES; Taxus™) reduced the incidence of restenosis and the need for revascularization over 6-12 months' follow-up compared with bare metal stents (BMSs). 2,3 Recent trials of DESs in acute myocardial infarction (AMI) have reported that DESs are superior to BMSs in reducing the need for repeat revascularization. [4][5][6][7] However, DES implantation in the AMI setting is still known to be an important off-label indication and safety concerns regarding stent thrombosis (ST) and associated major adverse cardiac events (MACE) have been raised because of the systemic thrombotic milieu of the early period of AMI and the combined potentially increased thrombogenicity of the DES itself by causing delayed healing of the coronary endothelium compared with BMSs. [8][9][10] However, recently the KAMIR (Korea AMI Registry) study group reported that the use of DESs in Korean patients with AMI was clinically safe and effective. 11 There is very limited information regarding the angiographic and clinical outcomes among the different DESs in patients with AMI undergoing PCI, especially DESs other than SES and PES. Park et al showed that SES implantation in AMI patients was associated with a reduction of angiographic restenosis at 6 months compared with PES. 12 However, to our knowledge, there are few ongoing studies and no published data comparing SES, PES, and zotarolimus-eluting stents (ZES; Endeavor™) in AMI patients undergoing PCI, so this study was designed to investigate whether there are differences in safety and efficacy, specifically the 6-month angiographic and 1-year clinical outcomes, in patients with AMI undergoing PCI with these 3 different major early-generation DESs.

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Clinical Safety of Drug-Eluting Stents in the Korea Acute Myocardial Infarction Registry

Cited by 41 publications

References 30 publications

Periodic Variation and Its Effect on Management and Prognosis of Korean Patients With Acute Myocardial Infarction

Periodic Variation and Its Effect on Management and Prognosis of Korean Patients With Acute Myocardial Infarction

Are Drug-Eluting Stents Safer and More Effective Than Bare-Metal Stents in Patients With Acute Myocardial Infarction? 3-Year Follow-Up

Lack of Clinical Benefit of Improved Angiographic Results With Sirolimus-Eluting Stents Compared With Paclitaxel and Zotarolimus-Eluting Stents in Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

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