Abstract 20552: Comparison of Outcome in Patients With ST-Elevation Myocardial Infarction Treated with Drug-Eluting Stents versus Bare Metal Stents in Eastern Denmark and Southern Sweden

Abstract

The prognosis of patients with ST-elevation myocardial infarction (STEMI) has improved significantly in the era of mechanical revascularization. Regional differences exist in the choice of stents. The aim of this study was to assess whether differences in preference of stents effect outcome in Danish and Swedish STEMI patients treated with either drug-eluting stents (DES) or bare metal stents (BMS) during percutaneous coronary intervention (PCI) in Eastern Denmark and Southern Sweden, respectively. Methods: We included 14,260 consecutive STEMI patients from 2003-2012 (59,708 patient-years of follow-up) treated in Eastern Denmark and Southern Sweden with either DES or BMS. Data were obtained from the Eastern Danish Heart Registry and the Swedish Coronary Angiography and Angioplasty Registry. Results: We identified 7828 (54.9%) Danish and 6,432 (45.1%) Swedish patients. Among Danish patients 76% (n=5966) received DES whereas 82% (n= 5254) of the Swedish patients received BMS. Overall 7116 (49.9%) patients were treated with DES and 7144 (50.1%) with BMS. Patients who received BMS were older (65.9 vs. 63.0) with a higher prevalence of hypertension (38.9 % vs. 36.3%) and history of myocardial infarction (13.0% vs. 9.2%) but with a lower prevalence of smoking (42.1% vs. 50.7%) and hyperlipidemia (20.7% vs. 24.3%, all p<0.01). Patients with BMS had a higher risk adjusted 30-day mortality (hazard ratio [HR] =1.3, CI 1.02-1.68, p<0.001) compared with DES. There was no statistically significant difference in mortality after 30 days and onwards (HR=0.96, CI 0.83-1.1, p=0.59) Conclusions: The use of DES is associated with a significantly lower 30-day mortality compared with BMS. After 30-days there is no difference in mortality between DES and BMS.