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New generation drug-eluting stents for ST-Elevation myocardial infarction: A new paradigm for safety.
MedLine Citation:
PMID:  24174334     Owner:  NLM     Status:  Publisher    
Objectives: The objective of this study is to compare the long term safety of new generation drug-eluting stents (DES) with early generation DES and bare metal stents (BMS) for ST-elevation myocardial infarction (STEMI). Background: Early generation DES for STEMI have reduced target vessel revascularization, but have more very late stent thrombosis (ST) compared with BMS raising concerns about their safety. New compared with early generation DES have lower rates of ST, but there are limited data in STEMI patients. Methods: From 2003-2011, 3,464 STEMI patients were treated with BMS (n=1,187), early generation DES (n=1,525) or new generation DES (n=752) and were followed for 1-9 years. Results: Patients with new generation DES were younger, had less cardiogenic shock and less prior infarction versus BMS, and more hypertension versus early generation DES. At 2 years, new generation DES had lower mortality (4.0% vs. 12.4%, p<0.001), similar reinfarction (4.4% vs. 5.1%, p=0.35), and less ST (1.4% vs. 3.8%, p=0.031) versus BMS; and similar mortality (4.0% vs. 5.8%, p=0.23), similar reinfarction (4.4% vs. 5.2%, p=0.64), and trends for less similar ST (1.4% vs. 3.3%, p=0.17) versus early generation DES. By Cox multivariable analyses, BMS had more ST than new generation DES (HR [95% CI] = 1.93 [1.01-3.66], p=0.045). Conclusions: New generation DES in STEMI patients have less ST compared to BMS and trends for less ST compared to early generation DES. These data suggest a new safety paradigm and should encourage the use of new generation DES in most STEMI patients treated with primary PCI. © 2013 Wiley Periodicals, Inc.
Ankit Garg; Bruce R Brodie; Thomas D Stuckey; Ross F Garberich; Patrick Tobbia; Charles Hansen; Grace Kissling; Hemal Kadakia; Daniel Lips; Timothy D Henry
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-10-30
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  -     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-10-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Wiley Periodicals, Inc., a Wiley company.
Internal Medicine Residency Program, Cone Health, Greensboro, North Carolina.
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