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Drug-eluting versus bare-metal stents in large coronary arteries of patients with ST-segment elevation myocardial infarction: Findings from the ICAS registry.
MedLine Citation:
PMID:  24685689     Owner:  NLM     Status:  Publisher    
BACKGROUND AND PURPOSE: There are a few retrospective subgroup analyses or registries of large-vessel (≥3.5mm) stenting. We investigated clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and bare-metal stents (BMS) in large coronary vessels.
METHODS AND SUBJECTS: Of 1100 STEMI patients registered in the Ibaraki Cardiovascular Assessment Study (ICAS) multicenter registry from April 2007 to June 2012 who underwent PCI, we enrolled 454 patients (65.8±12.7 years old, 81% male) with ≥3.5-mm stents. We excluded 53 patients with cardiogenic shock or left main trunk lesions. The remaining 401 patients were divided into Group-D, PCI with DES (n=184), and Group-B, PCI with BMS (n=217). Propensity score analysis matched 1:1 according to treatment with DES (n=101) or with BMS (n=101). We evaluated major adverse cardiac and cerebrovascular events (MACCE) and incidence of stent thrombosis (ST). MACCE was defined as all-cause death, myocardial infarction (MI), target-vessel revascularization (TVR), or cerebrovascular accident (CVA).
ESSENTIAL RESULTS: During a mean follow-up period of 526 days, all-cause death, MI, CVA, MACCE, and ST were not significantly different in Group-D versus Group-B (all-cause death: 4.35% vs. 4.61%, p=0.90; MI: 0% vs. 0%; CVA: 2.72% vs. 3.23%, p=0.76; MACCE: 15.2% vs. 20.3%, p=0.19; and ST: 0.0% vs. 1.38%, p=0.11). After adjusting for age, insulin use, multivessel disease, intra-aortic balloon pump use, culprit lesions, and estimated glomerular filtration rate <60ml/min/1.73m(2), MACCE was not significantly different between the groups (odds ratio: 0.69; 95% CI: 0.40-1.23; p=0.21). However, TVR was significantly lower in Group-D than Group-B in Kaplan-Meier analysis (p=0.048) after propensity score matching.
PRINCIPAL CONCLUSION: There was no advantage to using a DES in large vessels for preventing a hard endpoint, whereas DES use resulted in a significant reduction in TVR in the patients with STEMI in this registry.
Daisuke Abe; Akira Sato; Tomoya Hoshi; Shunsuke Maruta; Masako Misaki; Yuki Kakefuda; Hiroaki Watabe; Daigo Hiraya; Shunsuke Sakai; Masayuki Kawabe; Noriyuki Takeyasu; Kazutaka Aonuma
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-3-28
Journal Detail:
Title:  Journal of cardiology     Volume:  -     ISSN:  1876-4738     ISO Abbreviation:  J Cardiol     Publication Date:  2014 Mar 
Date Detail:
Created Date:  2014-4-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804703     Medline TA:  J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
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