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Previous Volume 359:1330-1342 September 25, 2008 Number 13 Next

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ABSTRACT

Background Studies comparing percutaneous coronary intervention (PCI) with drug-eluting and bare-metal coronary stents in acute myocardial infarction have been limited in size and duration.

Methods We identified all adults undergoing PCI with stenting for acute myocardial infarction between April 1, 2003, and September 30, 2004, at any acute care, nonfederal hospital in Massachusetts with the use of a state-mandated database of PCI procedures. We performed propensity-score matching on three groups of patients: all patients with acute myocardial infarction, all those with acute myocardial infarction with ST-segment elevation, and all those with acute myocardial infarction without ST-segment elevation. Propensity-score analyses were based on clinical, procedural, hospital, and insurance information collected at the time of the index procedure. Differences in the risk of death between patients receiving drug-eluting stents and those receiving bare-metal stents were determined from vital-statistics records.

Results A total of 7217 patients were treated for acute myocardial infarction (4016 with drug-eluting stents and 3201 with bare-metal stents). According to analysis of matched pairs, the 2-year, risk-adjusted mortality rates were lower for drug-eluting stents than for bare-metal stents among all patients with myocardial infarction (10.7% vs. 12.8%, P=0.02), among patients with myocardial infarction with ST-segment elevation (8.5% vs. 11.6%, P=0.008), and among patients with myocardial infarction without ST-segment elevation (12.8% vs. 15.6%, P=0.04). The 2-year, risk-adjusted rates of recurrent myocardial infarction were reduced in patients with myocardial infarction without ST-segment elevation who were treated with drug-eluting stents, and repeat revascularization rates were significantly reduced with the use of drug-eluting stents as compared with bare-metal stents in all groups.

Conclusions In patients presenting with acute myocardial infarction, treatment with drug-eluting stents is associated with decreased 2-year mortality rates and a reduction in the need for repeat revascularization procedures as compared with treatment with bare-metal stents.

Source Information

From Brigham and Women's Hospital (L.M., P.G., M.R.V., Z.Z.), the Harvard Clinical Research Institute (L.M.), Harvard Medical School (L.M., T.S.S., R.E.W., K.Z., A.L., S.-L.T.N.), and the Harvard School of Public Health (S.-L.T.N.) — all in Boston.

Address reprint requests to Dr. Mauri at Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, or at lmauri1{at}partners.org.

Full Text of this Article

This article has been cited by other articles:

• Mauri, L., Silbaugh, T. S., Wolf, R. E., Zelevinsky, K., Lovett, A., Zhou, Z., Resnic, F. S., Normand, S.-L. T. (2008). Long-Term Clinical Outcomes After Drug-Eluting and Bare-Metal Stenting in Massachusetts. Circulation 118: 1817-1827 [Abstract] [Full Text]  
• (2008). Drug-Eluting Stents Beat Bare-Metal Stents in Acute MI Analysis. Journal Watch Cardiology 2008: 2-2 [Full Text]  
• Bates, E. R. (2008). Primary Percutaneous Coronary Intervention With Drug-Eluting Stents: Another Chapter in the Stent Controversy. Circ Cardiovasc Intervent 1: 87-89 [Full Text]  
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