Midterm outcomes of bare-metal stenting after primary stenting for ST-segment elevated myocardial infarctions in the drug-eluting stent era: a propensity score-matched comparison with sirolimus-eluting stent

Abstract

We performed a propensity score-matching comparison of the midterm clinical and angiographic outcomes after primary stenting between using bare-metal stents (BMSs) and sirolimus-eluting stent (SES; Cypher Bx Velocity) for ST-segment elevated myocardial infarction (STEMI), because, in the drug-eluting stent era, the indication of the BMSs when a large balloon diameter is required remained to be controversial. This was a single-center, nonrandomized, retrospective study investigated in October 2013 by enrolling STEMI patients treated with primary stenting using either SES (n = 468) or BMS (n = 171) between September 2004 and December 2011. In 204 patients, the baseline-adjusted values produced similar mean maximum balloon sizes (BMS 3.67 ± 0.47 mm; SES 3.70 ± 0.56 mm; p = 0.477), and the incidence rates of binary in-stent restenosis (% diameter stenosis >50 % on secondary angiography) after SES placement (7.8 %) was significantly lower than that after BMS placement (23.5 %; p = 0.002). In baseline-adjusted 300 patients, the incidence of the clinical endpoints comprising cardiac death, nonfatal recurrent MI, and definite stent thrombosis after SES placement (11.3 %; 1241 ± 786 days; p = 0.557) was not significantly different from after BMS placement (8.7 %; mean follow-up period, 549 ± 486 days; p = 0.557). SES was not significantly related to the clinical endpoint [hazard ratio 2.31; 95 % confidence interval (CI) 0.88-6.08; p = 0.089). BMS did not offset the SES's angiographic efficacy for primary stenting for STEMI patients, despite placed using a large-sized balloon.

Propensity-Score Matched Comparison of Midterm Angiographic Outcomes of Sirolimus- Versus Everolimus- and Biolimus-Eluting Stents for <i>De Novo</i> Coronary Stenosis

“…The present mean balloon diameter of the stent (near 3.50 mm) and postprocedural reference diameter (≥ 3.10 mm) indicated that large vessels were treated in the present cohort because the frequency of TLR after a bare-metal stent (BMS) was relatively low in these baselines. [21][22][23][24] Considering this background, the present study showed far better angiographic outcomes for BES compared to SES, because SES showed a prominent advantage for angiographic outcomes in large vessels compared to the contemporary BMS 23) and zotarolimus-eluting stent, 24) and because angiographic efficacy was equal in large vessels between SES and EES in terms of target vessel failure. 23) Accordingly, the present study is the first to show the efficacy of BES on midterm angiographic outcomes compared to SES after being used in a clinical setting.…”

Very long-term clinical and angiographic outcomes after sirolimus- and paclitaxel-eluting stent placement for ST-elevation myocardial infarction: a propensity score-matched comparison

“…Concerning about the outcomes after primary stenting for patients with STEMI, we previously reported the long-term clinical and angiographic outcomes of BMS vs. SES [1,4], and SES vs. PES [10]. The frequencies of severe cardiac event were statistically equivalent in each paper.…”

“…Periprocedural anti-platelet therapy was administered as previously reported [1,4]. In the emergency care unit before primary percutaneous coronary intervention (PCI) was performed, aspirin (162-200 mg) and ticlopidine (200 mg) or clopidogrel (300 mg) was immediately administered orally.…”

“…The quantitative coronary artery angiography (QCA) parameters were measured using the TCS cardiovascular network systems (CAAS-2 and CAAS-5 systems, The Netherlands), as previously described [4]. Values were Very long-term clinical and angiographic outcomes after sirolimus-and paclitaxel-eluting… obtained at three points: before PCI (pre-procedural), immediately after successful PCI (post-procedural), and at the chronic phase (follow-up).…”

“…The long-term safety and efficacy of sirolimus-eluting stents (SESs; Cypher Bx Velocity; Cordis Corp., Miami, FL, USA) for use in primary stenting in patients with STelevation myocardial infarction (STEMI) in comparison with those of bare-metal stents (BMSs) have been established in Japan [1][2][3][4] (Ref. [1]: mean follow-up for SES, 1327 ± 415 days; for BMS, 1818 ± 681 days).…”