J Korean Med Sci.  2011 Apr;26(4):521-527. 10.3346/jkms.2011.26.4.521.

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

• Sim DS
• Jeong MH
• Ahn Y
• Kim YJ
• Chae SC
• Hong TJ
• Seong IW
• Chae JK
• Kim CJ
• Cho MC
• Seung KB
• Park SJ
• other Korea Acute Myocardial Infarction Registry (KAMIR) Investigators

• KMID: 1777882
• DOI: http://doi.org/10.3346/jkms.2011.26.4.521

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 (> or = 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.

Keyword

Myocardial Infarction; Drug-Eluting Stents

MeSH Terms

Acute Disease
Adult
Aged
*Angioplasty, Balloon, Coronary/adverse effects/instrumentation
Coronary Angiography
Coronary Vessels/pathology
*Drug-Eluting Stents/adverse effects
Female
Follow-Up Studies
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Infarction/mortality/radiography/*therapy
*Stents/adverse effects
Survival Rate
Time Factors

Figure

• 

  Fig. 1 Target lesion revascularization (TLR)-free survival at 12 months. BMS, bare-metal stents; DES, drug-eluting stents; PCI, percutaneous coronary intervention.

• 

  Fig. 2 Death/MI-free survival at 12 months. TLR, target lesion revascularization; BMS, bare-metal stents; DES, drug-eluting stents; PCI, percutaneous coronary intervention.

Reference

1. Kastrati A, Schömig A, Elezi S, Schühlen H, Dirschinger J, Hadamitzky M, Wehinger A, Hausleiter J, Walter H, Neumann FJ. Predictive factors of restenosis after coronary stent placement. J Am Coll Cardiol. 1997. 30:1428–1436.

2. Elezi S, Kastrati A, Neumann FJ, Hadamitzky M, Dirschinger J, Schömig A. Vessel size and long-term outcome after coronary stent placement. Circulation. 1998. 98:1875–1880.

3. Agostoni P, Biondi-Zoccai GG, Gasparini GL, Anselmi M, Morando G, Turri M, Abbate A, McFadden EP, Vassanelli C, Zardini P, Colombo A, Serruys PW. Is bare-metal stenting superior to balloon angioplasty for small vessel coronary artery disease? Evidence from a meta-analysis of randomized trials. Eur Heart J. 2005. 26:881–889.

4. Regar E, Serruys PW, Bode C, Holubarsch C, Guermonprez JL, Wijns W, Bartorelli A, Constantini C, Degertekin M, Tanabe K, Disco C, Wuelfert E, Morice MC. 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. Circulation. 2002. 106:1949–1956.

5. Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O'Shaughnessy C, Caputo RP, Kereiakes DJ, Williams DO, Teirstein PS, Jaeger JL, Kuntz RE. SIRIUS Investigators. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med. 2003. 349:1315–1323.

6. Stone GW, Ellis SG, Cox DA, Hermiller J, O'Shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, Popma JJ, Russell ME. TAXUS-IV Investigators. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med. 2004. 350:221–231.

7. Dawkins KD, Grube E, Guagliumi G, Banning AP, Zmudka K, Colombo A, Thuesen L, Hauptman K, Marco J, Wijns W, Popma JJ, Koglin J, Russell ME. 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. Circulation. 2005. 112:3306–3313.

8. Stone GW, Ellis SG, Cannon L, Mann JT, Greenberg JD, Spriggs D, O'Shaughnessy CD, DeMaio S, Hall P, Popma JJ, Koglin J, Russell ME. 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. JAMA. 2005. 294:1215–1223.

9. Ardissino D, Cavallini C, Bramucci E, Indolfi C, Marzocchi A, Manari A, Angeloni G, Carosio G, Bonizzoni E, Colusso S, Repetto M, Merlini PA. SES-SMART Investigators. Sirolimus-eluting vs. uncoated stents for prevention of restenosis in small coronary arteries: a randomized trial. JAMA. 2004. 292:2727–2734.

10. Sim DS, Kim JH, Jeong MH. Differences in clinical outcomes between patients with ST-elevation versus non-ST-elevation acute myocardial infarction in Korea. Korean Circ J. 2009. 39:297–303.

11. Sim DS, Jeong MH, Kang JC. Current management of acute myocardial infarction: experience from the Korea Acute Myocardial Infarction Registry. J Cardiol. 2010. 56:1–7.

12. Moses JW, Mehran R, Nikolsky E, Lasala JM, Corey W, Albin G, Hirsch C, Leon MB, Russell ME, Ellis SG, Stone GW. Outcomes with the paclitaxel-eluting stent in patients with acute coronary syndromes: analysis from the TAXUS-IV trial. J Am Coll Cardiol. 2005. 45:1165–1171.

13. Spaulding C, Henry P, Teiger E, Beatt K, Bramucci E, Carrié D, Slama MS, Merkely B, Erglis A, Margheri M, Varenne O, Cebrian A, Stoll HP, Snead DB, Bode C. TYPHOON Investigators. Sirolimus-eluting versus uncoated stents in acute myocardial infarction. N Engl J Med. 2006. 355:1093–1104.

14. Valgimigli M, Percoco G, Malagutti P, Campo G, Ferrari F, Barbieri D, Cicchitelli G, McFadden EP, Merlini F, Ansani L, Guardigli G, Bettini A, Parrinello G, Boersma E, Ferrari R. STRATEGY Investigators. Tirofiban and sirolimus-eluting stent vs. abciximab and bare-metal stent for acute myocardial infarction: a randomized trial. JAMA. 2005. 293:2109–2117.

15. Menichelli M, Parma A, Pucci E, Fiorilli R, De Felice F, Nazzaro M, Giulivi A, Alborino D, Azzellino A, Violini R. Randomized trial of sirolimus-eluting stent versus bare-metal stent in acute myocardial infarction (SESAMI). J Am Coll Cardiol. 2007. 49:1924–1930.

16. Kelbaek H, Thuesen L, Helqvist S, Clemmensen P, Kløvgaard L, Kaltoft A, Andersen B, Thuesen H, Engstrøm T, Bøtker HE, Saunamäki K, Krusell LR, Jørgensen E, Hansen HH, Christiansen EH, Ravkilde J, Køber L, Kofoed KF, Terkelsen CJ, Lassen JF. DEDICATION Investigators. Drug-eluting 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. Circulation. 2008. 118:1155–1162.

17. Stone GW, Lansky AJ, Pocock SJ, Gersh BJ, Dangas G, Wong SC, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Möckel M, Ochala A, Kellock A, Parise H, Mehran R. HORIZONS-AMI Trial Investigators. Paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction. N Engl J Med. 2009. 360:1946–1959.

18. Valgimigli M, Campo G, Arcozzi C, Malagutti P, Carletti R, Ferrari F, Barbieri D, Parrinello G, Percoco G, Ferrari R. Two-year clinical follow-up 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. J Am Coll Cardiol. 2007. 50:138–145.

19. Mauri L, Silbaugh TS, Garg P, Wolf RE, Zelevinsky K, Lovett A, Varma MR, Zhou Z, Normand SL. Drug-eluting or bare-metal stents for acute myocardial infarction. N Engl J Med. 2008. 359:1330–1342.

20. Di Lorenzo E, Sauro R, Varricchio A, Carbone G, Cortese G, Capasso M, Lanzillo T, Manganelli F, Mariello C, Siano F, Pagliuca MR, Stanco G, Rosato G, De Luca G. 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. Circulation. 2009. 120:964–972.

21. Anderson HV, Smalling RW, Henry TD. Drug-eluting stents for acute myocardial infarction. J Am Coll Cardiol. 2007. 49:1931–1933.

22. Brar SS, Leon MB, Stone GW, Mehran R, Moses JW, Brar SK, Dangas G. Use of drug-eluting stents in acute myocardial infarction: a systematic review and meta-analysis. J Am Coll Cardiol. 2009. 53:1677–1689.

23. Hoffmann R, Mintz GS. Coronary in-stent restenosis - predictors, treatment and prevention. Eur Heart J. 2000. 21:1739–1749.

24. Stone GW, Ellis SG, Cox DA, Hermiller J, O'Shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, Popma JJ, Russell ME. TAXUS-IV Investigators. One-year clinical results with slow-release, polymer-based, paclitaxel-eluting TAXUS stent: TAXUS-IV trial. Circulation. 2004. 109:1942–1947.

25. Steinberg DH, Mishra S, Javaid A, Slottow TL, Buch AN, Roy P, Okabe T, Smith KA, Torguson R, Xue Z, Pichard AD, Satler LF, Kent KM, Suddath WO, Waksman R. Comparison of effectiveness of bare metal stents versus drug-eluting stents in large (> or =3.5 mm) coronary arteries. Am J Cardiol. 2007. 99:599–602.

26. Quizhpe AR, Feres F, de Ribamar Costa J Jr, Abizaid A, Maldonado G, Costa R, Abizaid A, Cano M, Moreira AC, Staico R, Mattos LA, Tanajura LF, Chaves A, Centemero M, Sousa AM, Sousa JE. Drug-eluting stents vs. bare metal stents for the treatment of large coronary vessels. Am Heart J. 2007. 154:373–378.

27. Na JO, Kim JW, Choi CU, Choi UJ, Shin SY, Lim HE, Kim EJ, Rha SW, Park CG, Seo HS, Oh DJ. Bare-metal stents versus drug-eluting stents in large (≥ 3.5 mm) single coronary artery: Angiographic and clinical outcomes at 6 months. J Cardiol. 2009. 54:108–114.

28. Pfisterer M, Brunner-La Rocca HP, Rickenbacher P, Hunziker P, Mueller C, Nietlispach F, Leibundgut G, Bader F, Kaiser C. 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. Eur Heart J. 2009. 30:16–24.

29. Schömig A, Kastrati A, Wessely R. Prevention of restenosis by systemic drug therapy: back to the future? Circulation. 2005. 112:2759–2761.

30. Cho JS, Jeong MH, Sim DS, Hong YJ, Lim KS, Kim JH, Kim HD, Baek JY, Yoon HJ, Her SH, Jin SW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Effects of combined therapy with ezetimibe plus simvastatin after drug-eluting stent implantation in a porcine coronary restenosis model. J Korean Med Sci. 2010. 25:716–722.