DES vs BMS in STEMI
Muralidhar R
Drug-Eluting Versus Bare Metal Stents in Patients With ST-Segment–Elevation Myocardial InfarctionEight-Month Follow-Up in the Drug Elution and Distal Protection in Acute Myocardial Infarction (DEDICATION) Trial
Henning Kelbæk, MD; Leif Thuesen, MD; Steffen Helqvist, MD; Peter Clemmensen, MD; Lene Kløvgaard, RN; Anne Kaltoft, MD; Bente Andersen, RN; Helle Thuesen, RN; Thomas Engstrøm, MD; Hans E. Bøtker, MD; Kari Saunamäki, MD; Lars R. Krusell, MD; Erik Jørgensen, MD; Hans-Henrik T. Hansen, MD; Evald H. Christiansen, MD; Jan Ravkilde, MD; Lars Køber, MD; Klaus F. Kofoed, MD; Christian J. Terkelsen, MD; Jens F. Lassen, MD, for the DEDICATION Investigators*
From the Medical Department B and Cardiac Catheterization Laboratory, Rigshospitalet, University of Copenhagen (H.K., S.H., P.C., L.K., B.A., T.E., K.S., E.J., H.-H.T.H., L.K., K.F.K.), and Department of Cardiology, Aarhus University Hospital, Skejby (L.T., A.K., H.T., H.E.B., L.R.K., E.H.C., J.R., C.J.T., J.F.L.), Denmark.
Correspondence to Henning Kelbæk, MD, Cardiac Catheterization Laboratory 2013, Rigshospitalet, 9 Blegdamsvej, DK-2100 Copenhagen Ø, Denmark. E-mail henning.kelbaek{at}rh.regionh.dk
Received October 5, 2007; accepted June 3, 2008.
Background— Implantation of drug-eluting stents (DES) limits the rate of coronary restenosis in most patients with coronary artery disease, but data are scarce with regard to their use in patients with ST-segment–elevation myocardial infarction and in connection with distal protection of the microvascular perfusion during primary percutaneous coronary intervention.
Methods and Results— We randomly assigned 626 patients referred within 12 hours from symptom onset of an ST-elevation myocardial infarction to have a DES or a bare metal stent implanted in the infarct-related lesion with or without distal protection during primary percutaneous coronary intervention. Quantitative coronary angiography was performed during the index treatment and 8 months later. The primary end point was loss of the lumen diameter in the infarct-related lesion induced by neointimal proliferation. Patients were comparable with regard to baseline demographic and angiographic characteristics. The mean late lumen loss was significantly lower in patients treated with a DES (0.06 mm; SD, 0.66 mm) than in patients who had a bare metal stent implanted (0.47 mm; SD, 0.69 mm; P<0.001). The rate of the composite end point of cardiac death, recurrent myocardial infarction, and target lesion revascularization was 8.6% in the DES group versus 14.4% in the bare metal stent group (P=0.03). Cardiac death occurred in 4.2% and 1.6% of the patients (P=0.09) and stent thrombosis occurred in 2.0% and 2.6% (P=0.72), respectively.
Conclusion— Implantation of DES improves the angiographic outcome and need for repeat revascularization without increasing the short-term risk of stent thrombosis but has a tendency to increase cardiac death in patients with ST-segment–elevation myocardial infarction.
Thanks & regards,
Muralidhar Rejeti.
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