Bivalirudin versus heparin and eptifibatide in patients undergoing rescue percutaneous coronary intervention

Abstract

Background: Drug-eluting stents (DES) reduce restenosis and target lesion revascularization (TLR). The safety and effectiveness of DES in Hispanic patients presenting with acute ST-segment elevation myocardial infarction (STEMI) are not well known. Methods: A nonrandomized, retrospective analysis was performed between 8/2002 and 10/2007 at an academic tertiary care hospital serving a primarily indigent population. A total of 170 patients received a DES (all paclitaxelcoated stents) and 98 received an uncoated stent (BMS). The incidence of cardiac death, myocardial infarction (MI), TLR, subacute stent thrombosis (SAT), and a composite of these events (MACE) was assessed at 1 year. Results: There were no differences in baseline clinical characteristics. There were significant reductions in MI [2.9% (n=5 DES) vs. 11.2% (n=11 BMS), P=.037] and TLR [6.0% (10) vs. 18.4% (18), P=.04]. SAT was increased in the DES group [6.5% (11) vs. 2.0% (2); P=.03]. MACE was 17.6% in the DES group and 33.6% in the BMS group (P=.017). Premature clopidogrel discontinuation (b6 months) was the etiology of SAT in nine of the 11 patients. All of the deaths in the DES group were associated with SAT. 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.