Second-Generation Drug-Eluting Stents Reduces Target Lesion Failure in AMI Patients

SAN FRANCISCO, CA—Treatment with second-generation drug-eluting stents (DES) is associated with decreased target lesion failure compared with bare metal stents (BMS) in patients with acute myocardial infarction (AMI), a study reported at ACC.13, the American College of Cardiology's 62nd Annual Scientific Session.

Noting that few studies have compared the efficacy and safety of the two types of stents, Sungmin Lim, MD, from the Catholic Medical Center, Catholic University of Korea, Seoul, Korea, and colleagues analyzed 1,267 consecutive patients who underwent percutaneous coronary intervention (PCI) using BMS or second-generation DES in the COREA-AMI (COnvergent REgistry Catholic and ChonnAm University for AMI) study.

Patients were enrolled from January 2004–December 2009. Cardiac death, non-fatal myocardial infarction (MI), target lesion revascularization, and target lesion failure—which included cardiac death, non-fatal MI, or target lesion revascularization—were compared by type of stent.

A total of 384 patients were treated with BMS and 883 patients were treated with second-generation DES. Median follow-up duration was 29 months.

Patients in the second-generation DES group were significantly older (65.6 vs. 62.0 years; P<0.001). In addition, significantly fewer patients in the DES group were male (63.5% vs. 73.5%; P=0.001) and had fewer stents (1.04 vs. 1.27; P<0.001).

The rate of cardiac death (18.5% vs. 8.4%, P<0.001), non-fatal MI (3.4% vs. 1.2%, P=0.01), target lesion revascularization (11.2% vs. 4.2%, P<0.001), and target lesion failure (30.3% vs. 13.8%, P<0.001) were higher in the BMS treatment group.

In a multivariate Cox hazard regression model, of the predictors of target lesion failure—second-generation DES, age, hypertension, current smoking, chronic kidney disease, Killip classification, and left ventricle ejection fraction—only second-generation DES independently reduced target lesion failure (HR 0.642 [0.481–0.857]; P=0.003.