OBJECTIVES: This study compares very late outcomes following primary percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI) with stenting versus balloon angioplasty (BA). BACKGROUND: Stenting compared with BA for STEMI improves outcomes at 6-12 months, but comparisons beyond 6-12 months have not been studied. Recent studies have shown that stent thrombosis (ST) continues to increase beyond 3-5 years and may be higher with drug-eluting stents (DES) than bare metal stents (BMS). We hypothesized that there may be a very late hazard with stenting versus BA due to very late ST. METHODS: From 1994 to 2010 consecutive patients with STEMI treated with BA (n = 601) or stenting (n = 1,594) were prospectively enrolled in our registry and followed for 1-16 years. RESULTS: Patients treated with BA were older, were more often female, had more three-vessel disease, and had smaller vessels. Stented patients had trends for less stent/lesion thrombosis (ST/LT) and target vessel (TV) reinfarction at 1 year. In landmark analyses >1 year, stented patients had more very late ST/LT (6.1% vs. 2.9%, P = 0.002) and more TV reinfarction (7.9% vs. 3.1%, P < 0.001) which remained significant after adjusting for baseline risk. The greatest differences in very late outcomes were between DES and BA, but there were also significant differences between BMS and BA. CONCLUSIONS: There appears to be a very late hazard with stenting versus BA for STEMI. These data should encourage new strategies for prevention of very late ST with both BMS and DES including the development of bio-absorbable polymers and stent platforms.
OBJECTIVES: This study compares very late outcomes following primary percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI) with stenting versus balloon angioplasty (BA). BACKGROUND: Stenting compared with BA for STEMI improves outcomes at 6-12 months, but comparisons beyond 6-12 months have not been studied. Recent studies have shown that stent thrombosis (ST) continues to increase beyond 3-5 years and may be higher with drug-eluting stents (DES) than bare metal stents (BMS). We hypothesized that there may be a very late hazard with stenting versus BA due to very late ST. METHODS: From 1994 to 2010 consecutive patients with STEMI treated with BA (n = 601) or stenting (n = 1,594) were prospectively enrolled in our registry and followed for 1-16 years. RESULTS:Patients treated with BA were older, were more often female, had more three-vessel disease, and had smaller vessels. Stented patients had trends for less stent/lesion thrombosis (ST/LT) and target vessel (TV) reinfarction at 1 year. In landmark analyses >1 year, stented patients had more very late ST/LT (6.1% vs. 2.9%, P = 0.002) and more TV reinfarction (7.9% vs. 3.1%, P < 0.001) which remained significant after adjusting for baseline risk. The greatest differences in very late outcomes were between DES and BA, but there were also significant differences between BMS and BA. CONCLUSIONS: There appears to be a very late hazard with stenting versus BA for STEMI. These data should encourage new strategies for prevention of very late ST with both BMS and DES including the development of bio-absorbable polymers and stent platforms.
Authors: Gregg W Stone; Cindy L Grines; David A Cox; Eulogio Garcia; James E Tcheng; John J Griffin; Giulio Guagliumi; Thomas Stuckey; Mark Turco; John D Carroll; Barry D Rutherford; Alexandra J Lansky Journal: N Engl J Med Date: 2002-03-28 Impact factor: 91.245
Authors: Donald E Cutlip; Stephan Windecker; Roxana Mehran; Ashley Boam; David J Cohen; Gerrit-Anne van Es; P Gabriel Steg; Marie-angèle Morel; Laura Mauri; Pascal Vranckx; Eugene McFadden; Alexandra Lansky; Martial Hamon; Mitchell W Krucoff; Patrick W Serruys Journal: Circulation Date: 2007-05-01 Impact factor: 29.690
Authors: Gregg W Stone; Bernhard Witzenbichler; Giulio Guagliumi; Jan Z Peruga; Bruce R Brodie; Dariusz Dudek; Ran Kornowski; Franz Hartmann; Bernard J Gersh; Stuart J Pocock; George Dangas; S Chiu Wong; Martin Fahy; Helen Parise; Roxana Mehran Journal: Lancet Date: 2011-06-12 Impact factor: 79.321
Authors: Bruce Brodie; Yashashwi Pokharel; Nathan Fleishman; Adam Bensimhon; Grace Kissling; Charles Hansen; Sally Milks; Michael Cooper; Christopher McAlhany; Tom Stuckey Journal: JACC Cardiovasc Interv Date: 2011-01 Impact factor: 11.195
Authors: L Maillard; M Hamon; K Khalife; P G Steg; F Beygui; J L Guermonprez; C M Spaulding; J M Boulenc; J Lipiecki; A Lafont; P Brunel; G Grollier; R Koning; P Coste; X Favereau; B Lancelin; E Van Belle; P Serruys; J P Monassier; P Raynaud Journal: J Am Coll Cardiol Date: 2000-06 Impact factor: 24.094
Authors: Neville Kukreja; Yoshinobu Onuma; Hector M Garcia-Garcia; Joost Daemen; Ron van Domburg; Patrick W Serruys Journal: JACC Cardiovasc Interv Date: 2009-06 Impact factor: 11.195
Authors: A Rodríguez; V Bernardi; M Fernández; C Mauvecín; F Ayala; O Santaera; J Martínez; E Mele; G S Roubin; I Palacios; J A Ambrose Journal: Am J Cardiol Date: 1998-06-01 Impact factor: 2.778