The Japanese experience with sirolimus-eluting stent implantation in the infarct-related artery: Five years of observation from the J-PMS study

Abstract

BackgroundLong-term outcome and safety concerns regarding drug-eluting stents (DES) for acute myocardial infarction (AMI) treatment is still debated. Methods and resultsWe analyzed data from 1937 patients with complete 5-year follow-up (94.5%) from a multicenter registry of sirolimus-eluting stents (J-PMS). The patients were divided into 2 groups: AMI (n=133) and non-AMI (n=1804) by clinical presentation of index procedure, and compared the outcomes. At 5-year follow-up, there were no significant differences in major adverse cardiac events (MACE), death, MI, or stent thrombosis between the groups. However, target vessel related events (TVF; revascularization, cardiac death, MI, thrombosis) were higher in the non-AMI group (p=0.03). In the early phase (0–6 months), MACE and death/MI were higher in the AMI group (6.0% vs. 3.0%; p=0.02 and 6.8% vs. 2.1%; p<0.001). However, in the late phase (6–60 months), there was a difference in TVF between the 2 groups, with a steady increase in the non-AMI group (p=0.03). Over 60% of patients with AMIs were started on dual antiplatelet therapy after stent implantation or on the same day. However, dual anti-platelet therapy duration was similar (867±18 days in the AMI and 727±57 days in the non-AMI group, p=0.5). Frequency of bleeding was similar. ConclusionFive-year observation of AMI treatment using drug-eluting stent compared with non-AMI has no clinical disadvantage.