Seung-Ho Hur1, In-Cheol Kim1, Ki-Bum Won1, Yun-Kyeong Cho1, Hyuck-Jun Yoon1, Chang-Wook Nam1, Kwon-Bae Kim1, Min-Seok Kim2, Jincheol Park2, Seung-Woon Rha3, Shung-Chull Chae4, Young-Jo Kim5, Chong-Jin Kim6, Myeong-Chan Cho7, Myung-Ho Jeong8, Young-Keun Ahn8, Hyo-Soo Kim9, Tae-Hoon Ahn10, Ki-Bae Seung11, Yangsoo Jang12, Jung-Han Yoon13, In-Whan Seong14, Taek-Jong Hong15, Jang-Ho Bae16, Seung-Jung Park17. 1. Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, South Korea. 2. Department of Statistics, Keimyung University, Daegu, South Korea. 3. Division of Cardiology, Korea University Guro Hospital, Seoul, South Korea. 4. Division of Cardiology, Kyungpook National University Hospital, Daegu, South Korea. 5. Division of Cardiology, Yeungnam University Hospital, Daegu, South Korea. 6. Division of Cardiology, Kyung Hee University Hospital, Seoul, South Korea. 7. Division of Cardiology, Chungbuk National University Hospital, Cheongju, South Korea. 8. Division of Cardiology, Chonnam National University Hospital, Gwangju, South Korea. 9. Division of Cardiology, Seoul National University Hospital, Seoul, South Korea. 10. Division of Cardiology, Gachon University Gil Hospital, Inchon, South Korea. 11. Division of Cardiology, Catholic University Hospital, Seoul, South Korea. 12. Division of Cardiology, Yonsei University Severance Hospital, Seoul, South Korea. 13. Division of Cardiology, Yonsei University Wonju Hospital, Wonju, South Korea. 14. Division of Cardiology, Chungnam National University Hospital, Daejeon, South Korea. 15. Division of Cardiology, Busan National University Hospital, Busan, South Korea. 16. Division of Cardiology, Konyang University Hospital, Daejeon, South Korea. 17. Division of Cardiology, Ulsan University Asan Medical Center, Seoul, South Korea.
Abstract
BACKGROUND: Despite improved long-term safety of biodegradable polymer (BP) drug-eluting stents (DES) compared to first-generation durable polymer (DP) DES, data on the safety and efficacy of BP-DES compared with second-generation (2G) DP-DES in patients with acute myocardial infarction (AMI) are limited. HYPOTHESIS: To evaluate the safety and efficacy of BP-DES compared with 2G-DP-DES in the higher stent thrombosis (ST) risk setting of AMI. METHODS: A total of 3359 AMI patients who received either BP-DES (n = 261) or 2G-DP-DES (n = 3098) were included from the Korea Acute Myocardial Infarction Registry (KAMIR). Differences in baseline clinical and angiographic characteristics were adjusted using a 1:5 propensity score matching analysis (n = 261 for BP-DES and n = 1305 for 2G-DP-DES). The primary outcome was the incidence of major adverse cardiac events (MACE) including all-cause death, recurrent myocardial infarction (re-MI), and target vessel revascularization (TVR). The rate of definite or probable ST was also investigated. RESULTS: In adjusted analysis, there was no significant difference between the 2 groups in baseline clinical and angiographic characteristics; 2-year MACE (10.7% and 9.9% in the BP-DES group and 2G-DP-DES group, respectively, P = 0.679); ST incidence (0.8% vs 0.9%, respectively, P = 1.0), and rates of all-cause death, re-MI, and TVR. By multivariate analysis, old age, diabetes mellitus, renal dysfunction, and left ventricular dysfunction were the independent predictors of MACE after BP-DES or 2G-DP-DES implantation. CONCLUSIONS: BP-DES and 2G-DP-DES appear to have comparable 2-year safety and efficacy for the treatment of AMI. However, longer-term follow-up is needed.
BACKGROUND: Despite improved long-term safety of biodegradable polymer (BP) drug-eluting stents (DES) compared to first-generation durable polymer (DP) DES, data on the safety and efficacy of BP-DES compared with second-generation (2G) DP-DES in patients with acute myocardial infarction (AMI) are limited. HYPOTHESIS: To evaluate the safety and efficacy of BP-DES compared with 2G-DP-DES in the higher stent thrombosis (ST) risk setting of AMI. METHODS: A total of 3359 AMI patients who received either BP-DES (n = 261) or 2G-DP-DES (n = 3098) were included from the Korea Acute Myocardial Infarction Registry (KAMIR). Differences in baseline clinical and angiographic characteristics were adjusted using a 1:5 propensity score matching analysis (n = 261 for BP-DES and n = 1305 for 2G-DP-DES). The primary outcome was the incidence of major adverse cardiac events (MACE) including all-cause death, recurrent myocardial infarction (re-MI), and target vessel revascularization (TVR). The rate of definite or probable ST was also investigated. RESULTS: In adjusted analysis, there was no significant difference between the 2 groups in baseline clinical and angiographic characteristics; 2-year MACE (10.7% and 9.9% in the BP-DES group and 2G-DP-DES group, respectively, P = 0.679); ST incidence (0.8% vs 0.9%, respectively, P = 1.0), and rates of all-cause death, re-MI, and TVR. By multivariate analysis, old age, diabetes mellitus, renal dysfunction, and left ventricular dysfunction were the independent predictors of MACE after BP-DES or 2G-DP-DES implantation. CONCLUSIONS:BP-DES and 2G-DP-DES appear to have comparable 2-year safety and efficacy for the treatment of AMI. However, longer-term follow-up is needed.