Korean J Intern Med.  2014 Jan;29(1):66-75. 10.3904/kjim.2014.29.1.66.

Long-term outcomes of intravascular ultrasound-guided implantation of bare metal stents versus drug-eluting stents in primary percutaneous coronary intervention

• Cho YK
• Hur SH
• Park NH
• Choi SW
• Sohn JH
• Cho HO
• Park HS
• Yoon HJ
• Kim H
• Nam CW
• Kim YN
• Kim KB

• KMID: 1792014
• DOI: http://doi.org/10.3904/kjim.2014.29.1.66

Abstract

BACKGROUND/AIMS
While drug-eluting stents (DESs) have shown favorable outcomes in ST-segment elevation myocardial infarction (STEMI) compared to bare metal stents (BMSs), there are concerns about the risk of stent thrombosis (ST) with DESs. Because intravascular ultrasound (IVUS) guidance may help optimize stent placement and improve outcomes in percutaneous coronary intervention (PCI) patients, we evaluated the impact of IVUS-guided BMS versus DES implantation on long-term outcomes in primary PCI.
METHODS
In all, 239 STEMI patients received DES (n = 172) or BMS (n = 67) under IVUS guidance in primary PCI. The 3-year incidence of major adverse cardiac events (MACEs) including death, myocardial infarction (MI), target vessel revascularization (TVR), and ST was evaluated.
RESULTS
There was no difference in all cause mortality or MI. However, the incidence of TVR was 23.9% with BMS versus 9.3% with DES (p = 0.005). Thus, the number of MACEs was significantly lower with DES (11.0% vs. 29.9%; p = 0.001). The incidence of definite or probable ST was not different (1.5% vs. 2.3%; p = 1.0). IVUS-guided DES implantation (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.08 to 0.78; p = 0.017), stent length (HR, 1.03; 95% CI, 1.00 to 1.06; p = 0.046), and multivessel disease (HR, 3.01; 95% CI, 1.11 to 8.15; p = 0.030) were independent predictors of MACE.
CONCLUSIONS
In patients treated with primary PCI under IVUS guidance, the use of DES reduced the incidence of 3-year TVR versus BMS. However, all cause mortality and MI were similar between the groups. The incidence of ST was low in both groups.

Keyword

Ultrasonography, interventional; Myocardial infarction; Drug-eluting stents

MeSH Terms

Aged
Drug-Eluting Stents/*statistics & numerical data
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Infarction/mortality/*surgery
Percutaneous Coronary Intervention/*instrumentation/statistics & numerical data
Reoperation/statistics & numerical data
Republic of Korea/epidemiology
Retrospective Studies
Treatment Outcome
*Ultrasonography, Interventional