TY - JOUR
T1 - Bare-metal stenting of large coronary arteries in ST-elevation myocardial infarction is associated with low rates of target vessel revascularization
AU - Shugman, Ibrahim M.
AU - Hee, Leia
AU - Mussap, Christian J.
AU - Diu, Patrick
AU - Lo, Sidney
AU - Hopkins, Andrew P.
AU - Nguyen, Phong
AU - Taylor, David
AU - Rajaratnam, Rohan
AU - Leung, Dominic
AU - Thomas, Liza
AU - Juergens, Craig P.
AU - French, John K.
PY - 2013
Y1 - 2013
N2 - Background During percutaneous coronary intervention (PCI) performed in the emergent setting of ST-segment elevation myocardial infarction (STEMI), uncertainty about patients’ ability to comply with 12 months dual antiplatelet therapy after drug-eluting stenting is common, and thus, selective bare-metal stent (BMS) deployment could be an attractive strategy if this achieved low target vessel revascularization (TVR) rates in large infarct-related arteries (IRAs) (≥3.5 mm). Methods and results To evaluate this hypothesis, among 1,282 patients with STEMI who underwent PCI during their initial hospitalization, we studied 1,059 patients (83%) who received BMS, of whom 512 (48%) had large IRAs ≥3.5 mm in diameter, 333 (31%) had IRAs 3 to 3.49 mm, and 214 (20%) had IRAs <3 mm. At 1 year, TVR rate in patients with BMS was 5.8% (2.2% with large BMS [≥3.5 mm], 9.2% with BMS 3-3.49 mm [intermediate], and 9.0% with BMS <3.0 mm [small], P <.001). The rates of death/reinfarction among patients with large BMS compared with intermediate BMS or small BMS were lower (6.6% vs 11.7% vs 9.0%, P =.042). Among patients who received BMS, the independent predictors of TVR at 1 year were the following: vessel diameter <3.5 mm (odds ratio [OR] 4.39 [95% CI 2.24-8.60], P <.001), proximal left anterior descending coronary artery lesions (OR 1.89 [95% CI 1.08-3.31], P =.027), hypertension (OR 2.01 [95% CI 1.17-3.438], P =.011), and prior PCI (OR 3.46 [95% CI 1.21-9.85], P =.02). The predictors of death/myocardial infarction at 1 year were pre-PCI cardiogenic shock (OR 8.16 [95% CI 4.16-16.01], P <.001), age ≥65 years (OR 2.63 [95% CI 1.58-4.39], P <.001), left anterior descending coronary artery culprit lesions (OR 1.95 [95% CI 1.19-3.21], P =.008), female gender (OR 1.93 [95% CI 1.12-3.32], P =.019), and American College of Cardiology/American Heart Association lesion classes B2 and C (OR 2.17 [95% CI 1.10-4.27], P =.026). Conclusion Bare-metal stent deployment in STEMI patients with IRAs ≥3.5 mm was associated with low rates of TVR. Their use in this setting warrants comparison with second-generation drug-eluting stenting deployment in future randomized clinical trials.
AB - Background During percutaneous coronary intervention (PCI) performed in the emergent setting of ST-segment elevation myocardial infarction (STEMI), uncertainty about patients’ ability to comply with 12 months dual antiplatelet therapy after drug-eluting stenting is common, and thus, selective bare-metal stent (BMS) deployment could be an attractive strategy if this achieved low target vessel revascularization (TVR) rates in large infarct-related arteries (IRAs) (≥3.5 mm). Methods and results To evaluate this hypothesis, among 1,282 patients with STEMI who underwent PCI during their initial hospitalization, we studied 1,059 patients (83%) who received BMS, of whom 512 (48%) had large IRAs ≥3.5 mm in diameter, 333 (31%) had IRAs 3 to 3.49 mm, and 214 (20%) had IRAs <3 mm. At 1 year, TVR rate in patients with BMS was 5.8% (2.2% with large BMS [≥3.5 mm], 9.2% with BMS 3-3.49 mm [intermediate], and 9.0% with BMS <3.0 mm [small], P <.001). The rates of death/reinfarction among patients with large BMS compared with intermediate BMS or small BMS were lower (6.6% vs 11.7% vs 9.0%, P =.042). Among patients who received BMS, the independent predictors of TVR at 1 year were the following: vessel diameter <3.5 mm (odds ratio [OR] 4.39 [95% CI 2.24-8.60], P <.001), proximal left anterior descending coronary artery lesions (OR 1.89 [95% CI 1.08-3.31], P =.027), hypertension (OR 2.01 [95% CI 1.17-3.438], P =.011), and prior PCI (OR 3.46 [95% CI 1.21-9.85], P =.02). The predictors of death/myocardial infarction at 1 year were pre-PCI cardiogenic shock (OR 8.16 [95% CI 4.16-16.01], P <.001), age ≥65 years (OR 2.63 [95% CI 1.58-4.39], P <.001), left anterior descending coronary artery culprit lesions (OR 1.95 [95% CI 1.19-3.21], P =.008), female gender (OR 1.93 [95% CI 1.12-3.32], P =.019), and American College of Cardiology/American Heart Association lesion classes B2 and C (OR 2.17 [95% CI 1.10-4.27], P =.026). Conclusion Bare-metal stent deployment in STEMI patients with IRAs ≥3.5 mm was associated with low rates of TVR. Their use in this setting warrants comparison with second-generation drug-eluting stenting deployment in future randomized clinical trials.
UR - http://handle.uws.edu.au:8081/1959.7/532673
U2 - 10.1016/j.ahj.2012.12.023
DO - 10.1016/j.ahj.2012.12.023
M3 - Article
SN - 0002-8703
VL - 165
SP - 591
EP - 599
JO - American Heart Journal
JF - American Heart Journal
IS - 4
ER -
