Primary Sirolimus-Eluting Stent Implantation for Patients with Acute ST-Segment Elevation Myocardial Infarction

Yang, Tae Hyun; Hong, Myeong Ki; Park, Kyoung Ha; Kim, Mi Jeong; Choi, Bong Ryong; Oh, Sung Ju; Lee, Bong Ki; Kim, Young Hak; Han, Ki Hoon; Lee, Cheol Whan; Kang, Duk Hyun; Song, Jae Kwan; Kim, Jae Joong; Park, Seong Wook; Park, Seung Jung

Abstract

BACKGROUND AND OBJECTIVES
Sirolimus-eluting stents (SES) have been shown to significantly inhibit neointimal hyperplasia, resulting in reduced restenosis compared with bare metal stents (BMS). However, the efficacy and safety of SES implantation for patients with acute ST-segment elevation myocardial infarction (STEMI) remain unclear.
SUBJECTS AND METHODS
Primary stenting was performed using SES in 74 patients (mean age: 58.0+/-12.7 years, 59 males) and BMS in 88 patients (mean age: 59.3+/-10.7 years, 63 males) between April 2003 and July 2004. We retrospectively compared the incidence of 6-month angiographic restenosis and the major adverse cardiac events (MACE) defined as cardiac death, non-fatal myocardial infarction and target lesion revascularization (TLR), between the SES group and the BMS group.
RESULTS
The SES group had smaller vessels (3.04+/-0.47 mm vs. 3.24+/-0.56 mm, respectively, p=0.02) and a longer stent length (33.7+/-14.3 mm vs. 25.0+/-9.6 mm, p=0.00). The procedural success rate (87.8% vs. 92.0%, respectively, p=0.37) and the peak creatine kinase-MB (239+/-196 ng/mL vs. 274+/-188 ng/mL, p=0.26) were similar. The 6-month angiographic restenosis rate (0.0% vs. 30.4%, respectively, p=0.00) and late loss (-0.03+/-0.55 mm vs. 1.28+/-0.58 mm, p=0.00) were significantly lower in the SES group compared with the BMS group. Stent thrombosis developed in only 1 case of the SES group (1.4% vs. 0.0%, respectively, p=0.45). At 6 months, SES implantation significantly reduced the incidence of MACE (6.9% vs. 19.5%, respectively, p=0.04), because of a reduction in the incidence of TLR (1.4% vs. 11.5%, p=0.01). Likewise, the MACE-free survival rate was significantly higher in the SES group (93.06% vs. 80.46%, respectively, p=0.03).
CONCLUSION
Compared with the BMS, the SES was effective in reducing the incidence of 6-month angiographic restenosis and MACE without any increased risk of stent thrombosis in the patients with STEMI who received primary stenting.