Midterm outcomes of bare-metal stenting after primary stenting for ST-segment elevated myocardial infarctions in the drug-eluting stent era: a propensity score-matched comparison with sirolimus-eluting stent.

Abstract

We performed a propensity score-matching comparison of the midterm clinical and angiographic outcomes after primary stenting between using bare-metal stents (BMSs) and sirolimus-eluting stent (SES; Cypher Bx Velocity) for ST-segment elevated myocardial infarction (STEMI), because, in the drug-eluting stent era, the indication of the BMSs when a large balloon diameter is required remained to be controversial. This was a single-center, nonrandomized, retrospective study investigated in October 2013 by enrolling STEMI patients treated with primary stenting using either SES (n=468) or BMS (n=171) between September 2004 and December 2011. In 204 patients, the baseline-adjusted values produced similar mean maximum balloon sizes (BMS 3.67±0.47mm; SES 3.70±0.56mm; p=0.477), and the incidence rates of binary in-stent restenosis (% diameter stenosis >50% on secondary angiography) after SES placement (7.8%) was significantly lower than that after BMS placement (23.5%; p=0.002). In baseline-adjusted 300 patients, the incidence of the clinical endpoints comprising cardiac death, nonfatal recurrent MI, and definite stent thrombosis after SES placement (11.3%; 1241±786days; p=0.557) was not significantly different from after BMS placement (8.7%; mean follow-up period, 549±486days; p=0.557). SES was not significantly related to the clinical endpoint [hazard ratio 2.31; 95% confidence interval (CI) 0.88-6.08; p=0.089). BMS did not offset the SES's angiographic efficacy for primary stenting for STEMI patients, despite placed using a large-sized balloon.