News:Drug eluting stents are associated with reduced mortality in patients with myocardial infarction at two years

March 30, 2008 By Vijayalakshmi Kunadian MBBS MD MRCP [mailto:vkunadian@perfuse.org]

Dr. Laura Mauri from Harvard Clinical Research Institute, Boston MA, presented the results at the SCAI-I2 summit Annual Scientific Sessions in Chicago today.

Although many randomized controlled studies have evaluated the use of drug-eluting stents (DES) in the absence of an acute myocardial infarction, few studies have evaluated their use in the setting of an infarct (both in the setting of a STEMI and NSTEMI). Therefore Dr. Mauri and colleagues from Boston studied patients who underwent percutaneous coronary intervention (PCI) with stenting for acute myocardial infarction between April 1 2003 and September 30, 2004. They collected information from the Massachusetts state database which monitors quality of care from all acute care non-US governmental hospitals in Massachusetts. This study grouped patients who received DES and bare metal stents (BMS) both in the setting of NSTEMI and STEMI.

In total there were 7216 patients who were treated with stenting in the setting of an infarct with both DES (n=4016) and BMS (n=3200). A total of 3835 patients underwent treatment for NSTEMI with DES or BMS (50.7% vs. 49.3%, p<0.0001) and 3381 patients underwent treatment for STEMI with DES or BMS (46.2% vs. 53.8%, p<0.001).

Among patients who received DES compared with those who received BMS there was a significant reduction in the unadjusted cumulative overall mortality for all patients (9% vs. 14%, p<0.001) at two years. The risk adjusted two year mortality rates were also significantly reduced for all patients (10.6% vs. 13.4%, p=0.002) at two years among those who received DES vs. BMS.

The investigators also demonstrated a significant reduction in the need for revascularization for all MI patients (p<0.001) both separately for patients with NSTEMI (p<0.001) and STEMI (p<0.001) for DES compared with BMS. Similarly, there was a significant reduction in the need for target vessel revascularization for all patients (p<0.001) both separately for patients with NSTEMI (p=0.02) and STEMI (p=0.002) at two years among those who received DES vs. BMS, respectively.

The authors concluded that the use of DES is associated with reduced mortality at two years among patients with an acute infarct and there is a reduced need for repeat target vessel revascularization in the setting of both STEMI and NSTEMI.

Source
Late Breaking Clinical Trials Session: SCAI Annual Scientific Sessions in partnership with ACC i2 summit, March 30, 2008 Chicago