Risk of Heart Failure in Patients with ST-Elevation Myocardial Infarction Receiving Drug-Eluting Stent Implantation and Undefined Duration of Antiplatelets.

Li-Nien Chien,Hung-Yi Liu,Ya-Hui Chang,Fa-Chang Yu,Chun-Chao Chen,Chen-Ting Tsai,Chao-Feng Lin,Hung-I Yeh

doi:10.3390/jpm12030369

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

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]

Methods

Results

Conclusion