Abstract

It remains unknown as to whether the use of new-generation drug-eluting stent (NG-DES) in patients with ST-elevation myocardial infarction (STEMI) who receive an undefined duration of dual antiplatelet therapy (DAPT) reduces the risk of hospitalization for heart failure (HHF). In this population-based retrospective cohort study, we applied propensity score matching to select 6831 pairs of patients with STEMI who had similar baseline characteristics and received either NG-DES or bare-metal stent (BMS) implantation between 1 January 2007 and 31 December 2016. The risk of stent-associated HHF was evaluated, wherein death was considered a competing risk. Rates of cumulative incidence competing risk for HHF at the 1, 2, 3, 4, and 5 year follow-up were lower in the NG-DES group (3.79%, 5.21%, 6.15%, 7.01%, and 8.29%, respectively) than in the BMS group (4.51%, 6.21%, 7.32%, 8.33%, and 9.83%, respectively). NG-DES implantation was associated with a lower risk of HHF than BMS implantation after 5 years, with an adjusted subdistribution hazard ratio of 0.82 (95% confidence interval 0.72–0.92, p = 0.001). These results accord with those of patients who received DAPT for >6 months. Our findings highlight that NG-DESs may reduce HHF risk in patients with STEMI receiving an undefined duration of DAPT.

Highlights

  • Compared with patients in the bare-metal stent (BMS) group, those in the new-generation drug-eluting stent (NG-DES) group had a higher prevalence of dyslipidemia; had a lower prevalence of cerebrovascular disease; had more frequently used beta-blockers and statins; had less frequently used pump inhibitors (PPIs), steroids, and nonsteroidal anti-inflammatory drugs (NSAIDs); had less frequently used IABP; and had lower ORBIT scores (Table 1)

  • The rates of cumulative incidence competing risk (CICR) of hospitalization for heart failure (HHF) after stent implantation at the 1, 2, 3, 4, and 5 year follow-up were lower in the NG-DES group (3.79%, 5.21%, 6.15%, 7.01%, and 8.29%, respectively) than in the BMS group (4.51%, 6.21%, 7.32%, 8.33%, and 9.83%, respectively; Figure 2)

  • We conducted an analysis based on types of NG-DESs categorized by their coated drugs (Table S2) and observed that the rates of CICR and the risk of stent-associated HHF were comparable among different NG-DESs

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Summary

Introduction

In a population-based cohort study [1], including a mean follow-up duration of 7.6 years, the mortality rates in patients who developed post-MI. HF were 70%, whereas those in patients who did not develop post-MI HF were 28%. Patients who had HF after discharge from the index MI admission had a worse outcome than did those patients who had HF during MI admission [1], indicating that a prevention strategy is required to reduce the long-term risk of HF after MI. The use of new-generation drug-eluting stent (NG-DES) in patients with STEMI has demonstrated superior benefits compared with that of bare-metal stent (BMS) in terms of target vessel failure (TVF) and repeat percutaneous coronary intervention (PCI) [2], all according to randomized controlled trial (RCT) [4–6] and meta-analysis [7,8] results. The aforementioned studies only investigated specific NG-DES types and did not measure the risk of new-onset HF after stent implantation as the principal study outcome [4–8]

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