Back to Search
Start Over
Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: 5 years follow-up from the randomized DEDICATION trial (Drug Elution and Distal Protection in Acute Myocardial Infarction).
- Source :
-
JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2013 Jun; Vol. 6 (6), pp. 548-53. Date of Electronic Publication: 2013 May 15. - Publication Year :
- 2013
-
Abstract
- Objectives: This study sought to compare the long-term effects of drug-eluting stent (DES) compared with bare-metal stent (BMS) implantation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention.<br />Background: The randomized DEDICATION (Drug Elution and Distal Protection in Acute Myocardial Infarction) trial evaluated the outcome after DES compared with BMS implantation in patients with STEMI undergoing primary percutaneous coronary intervention.<br />Methods: Patients with a high-grade stenosis/occlusion of a native coronary artery presenting with symptoms <12 h and ST-segment elevation were enrolled after giving informed consent. Patients were randomly assigned to receive a DES or a BMS in the infarct-related lesion. Patients were followed for at least 5 years, and clinical endpoints were evaluated from population registries and hospital charts. The main endpoint was the occurrence of the first major adverse cardiac event (MACE), defined as cardiac death, nonfatal recurrent myocardial infarction, and target lesion revascularization.<br />Results: Complete clinical status was available in 623 patients (99.5%) at 5 years follow-up. The combined MACE rate was insignificantly lower in the DES group (16.9% vs. 23%), mainly driven by a lower need of repeat revascularization (p = 0.07). Whereas the number of deaths from all causes tended to be higher in the DES group (16.3% vs. 12.1%, p = 0.17), cardiac mortality was significantly higher (7.7% vs. 3.2%, p = 0.02). The 5-year stent thrombosis rates were generally low and similar between the DES and the BMS groups. No cardiac deaths occurring within 1 month could be clearly ascribed to stent thrombosis, whereas stent thrombosis was involved in 78% of later-occurring deaths.<br />Conclusions: The 5-year MACE rate was insignificantly different, but the cardiac mortality was higher after DES versus BMS implantation in patients with STEMI. Stent thrombosis was the main cause of late cardiac deaths.<br /> (Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Chi-Square Distribution
Coronary Stenosis complications
Coronary Stenosis diagnosis
Coronary Stenosis mortality
Coronary Thrombosis etiology
Coronary Thrombosis mortality
Denmark
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Infarction diagnosis
Myocardial Infarction etiology
Myocardial Infarction mortality
Percutaneous Coronary Intervention adverse effects
Percutaneous Coronary Intervention mortality
Proportional Hazards Models
Prosthesis Design
Recurrence
Registries
Risk Factors
Time Factors
Treatment Outcome
Coronary Stenosis therapy
Drug-Eluting Stents
Metals
Myocardial Infarction therapy
Percutaneous Coronary Intervention instrumentation
Stents
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7605
- Volume :
- 6
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 23683734
- Full Text :
- https://doi.org/10.1016/j.jcin.2012.12.129