Abstract 2567: Paclitaxel Eluting Stents are associated with a high rate of Stent Thrombosis compared to Bare Metal Stents in an Underserved Hispanic Population Presenting with Acute ST Segment Myocardial Infarction

Abstract

Background: Paclitaxel-eluting stents (PES) are shown to reduce restenosis and target lesion revascularization (TLR). The effectiveness of PES in Hispanic patients who present with acute myocardial infarction with ST segment elevation (STEMI) is not well established. Methods: A non-randomized, retrospective analysis was performed on 236 Hispanic patients presenting with STEMI between 8/2002 and 4/2006 at an academic tertiary care hospital serving a primarily indigent population. 150 patients received a PES and 86 received an uncoated stent (BMS). The incidence of cardiac death, myocardial infarction (MI), TLR, subacute thrombosis (SAT), and a composite of these major adverse cardiac events (MACE) was assessed at 1 year. Results: Baseline clinical characteristics in both groups revealed no statistically significant differences. All patients had clinical follow up at one year. There were statistically significant reductions in MI [2.0% (n=3 PES) vs. 10.5% (n=9 BMS), p=0.037] and TLR [6.0% (9) vs. 18.6% (16), p=0.04]. There was no difference in death [0.7% (1) vs. 1.1% (1), p=0.99]. SAT was increased in the PES group (6.0%, n=9) compared to the BMS group (1.1%, n=1, p=0.03). MACE was 14.7% in the PES group and 31.2% in the BMS group (p=0.017). Premature clopidogrel discontinuation (<6 months) was the etiology of SAT in 8 of the 9 patients. Conclusions: Use of DES is associated with lower rates of MI and TLR in Hispanics presenting with STEMI. There is an increased incidence of SAT in this population primarily due to premature clopidogrel discontinuation. The role of socioeconomic factors in premature antiplatelet discontinuation and its effects on SAT need further evaluation.