Comparison of long term clinical outcomes between bare metal stent versus different types of drug eluting stents for treatment of acute myocardial infarction

Abstract

Purpose: To overcome the intrastent restenosis (ISR) and stent thrombosis (ST), people have tried to make a perfect stent. Accordingly, now we come to have a lot of developed type of coronary stents. However, there is paucity of data to exclusively evaluate the safety and efficacy of bare metal stent (BMS) and different types of drug-eluting stents (DES) in the setting of AMI. The purpose of this study was to compare the clinical outcome of four different types of coronary stent including BMS, 1st generation DES, 2nd generation plus new generation DES, and most recently biodegradable polymer-coated stent in treatment of acute myocardial infarction. Methods: From Korean Acute Myocardial Infarction Registry (KAMIR) database, a total of 9,919 patients with acute myocardial infarction (MI) who underwent primary percutaneous coronary intervention (PCI) with BMS or DES were enrolled in this study. The patients were divided into four groups; BMS group (n=821), 1st generation DES group (n=2,751), 2nd generation plus new generation DES group (n=5,324), and biodegradable polymer coating stent group (n=303). The primary endpoints included major adverse cardiovascular events (MACE), such as death, MI, or revascularization including re-PCI and coronary artery bypass graft surgery (CABG), and stent thrombosis at one year follow up. Results: Baseline characteristics were similar between four groups. At one year follow up, MACE rate in the BMS, 1st generation DES, 2nd generation plus new generation DES, and biodegradable DES groups were 12.3%, 8.1%, 5.3% and 3.9%, respectively (p<0.0001). There were 104 cases of stent thrombosis of all cohorts, and the incidence of stent thrombosis was the lowest in the biodegradable DES group among the 4 groups (2.5%, 2.0%, 1.4%, 0.7%, p=0.007). After the adjustment of age, male gender, ST-segment elevation myocardial infarction (SETMI), left ventricular ejection fraction, stent number and length, stent type was significant predictor for one year MACE (Odds ratio of 1st, 2nd+new generation, biodegradable polymer coated stent group compared to BMS group: 0.62, 0.37, 0.27, respectively, p<0.05 for all). Conclusion: From our result, biodegradable polymer coated stent was the most efficacious and safest stent in acute MI at one year follow up.