DES in PCI procedures has better outcomes for STEMI patients

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CHICAGO—The use of drug-eluting (DES) in PCI for ST-segment elevation myocardial infarction (STEMI) patients was associated with better two-year outcomes than with bare-metal stents (BMS) in a real-world, single-center experience, according to a Wake Forest University study presented by Sanjay K. Gandhi, MD, at the 2008 American College of Cardiology (ACC) Scientific Sessions on Saturday. 

Ghandi, in his presentation said that although PCI with coronary stenting is a standard therapy for STEMI, recent trial data suggest that the use of DES for STEMI is associated with worse outcomes in comparison to BMS. As a result, Ghandi and his colleagues at Wake Forest in Winston-Salem, N.C., undertook the study to determine whether DES for STEMI in routine clinical practice is associated with worse outcomes than BMS.

“BMS for early PCI in the treatment STEMI improves clinical outcomes,” he said. “However, the role of DES in STEMI is unclear when comparing outcomes in STEMI patients.”

The researchers reviewed the clinical outcomes for all patients hospitalized at Wake Forest University Baptist Medical Center in Winston-Salem, N.C., for STEMI from April 2002 to April 2005, who underwent PCI within 24 hours.

BMS were implanted in 252 patients and DES were implanted in 257 patients. The two year follow-up was 82 percent in the BMS group, and 85 percent in the DES group; altogether 509 patients with STEMI were hospitalized April 2002, and included in the trial, according to Ghandi.

“The choice of stent type [BMS or DES] was at the discretion of the individual interventional cardiologist,” he said. To accurately assess the stents, they matched baseline clinical characteristics with propensity scores.

After the researchers completed the matching, they were left with 192 patients with BMS, and 192 patients with DES, who were matched for heart failure and for baseline procedural characteristics.

Ghandi noted that statin use was higher in BMS group at one month, but leveled after one month.

Overall, he reported that the Wake Forest researchers found that the target vessel revascularization (TVR) was significantly lower in DES compared to BMS group at two years. For stent thrombosis at two years, Ghandi said that DES favored, but was not statistically significant.

He also reported that the Kaplan Meier plot of cumulative of non-fatal MI or cardiac death: BMS was statistically significantly higher—12 percent in the DES group, compared to 21 percent in BMS group.

“Overall, DES for STEMI was associated with similar or better two-year outcomes compared to BMS, and there was a sustained benefit of TVR associated with DES use,” he noted.

Ghandi concluded that the use of DES for STEMI may convey a long-term benefit in reduction of TVR, non-fatal MI or death and mortality compared to BMS.