TY - JOUR

T1 - Drug-eluting versus bare metal stents in patients with st-segment-elevation myocardial infarction: eight-month follow-up in the Drug Elution and Distal Protection in Acute Myocardial Infarction (DEDICATION) trial

AU - Kelbaek, Henning

AU - Thuesen, Leif

AU - Helqvist, Steffen

AU - Clemmensen, Peter

AU - Kløvgaard, Lene

AU - Kaltoft, Anne

AU - Andersen, Bente

AU - Thuesen, Helle

AU - Engstrøm, Thomas

AU - Bøtker, Hans E

AU - Saunamäki, Kari

AU - Krusell, Lars R

AU - Jørgensen, Erik

AU - Hansen, Hans-Henrik T

AU - Christiansen, Evald H

AU - Ravkilde, Jan

AU - Køber, Lars

AU - Kofoed, Klaus F

AU - Terkelsen, Christian J

AU - Lassen, Jens F

AU - DEDICATION Investigators

N1 - Keywords: Angioplasty, Transluminal, Percutaneous Coronary; Cell Proliferation; Coronary Angiography; Coronary Artery Disease; Coronary Stenosis; Death; Drug-Eluting Stents; Follow-Up Studies; Humans; Myocardial Infarction; Stents; Thrombosis; Treatment Outcome; Tunica Intima

PY - 2008

Y1 - 2008

N2 - BACKGROUND: Implantation of drug-eluting stents (DES) limits the rate of coronary restenosis in most patients with coronary artery disease, but data are scarce with regard to their use in patients with ST-segment-elevation myocardial infarction and in connection with distal protection of the microvascular perfusion during primary percutaneous coronary intervention. METHODS AND RESULTS: We randomly assigned 626 patients referred within 12 hours from symptom onset of an ST-elevation myocardial infarction to have a DES or a bare metal stent implanted in the infarct-related lesion with or without distal protection during primary percutaneous coronary intervention. Quantitative coronary angiography was performed during the index treatment and 8 months later. The primary end point was loss of the lumen diameter in the infarct-related lesion induced by neointimal proliferation. Patients were comparable with regard to baseline demographic and angiographic characteristics. The mean late lumen loss was significantly lower in patients treated with a DES (0.06 mm; SD, 0.66 mm) than in patients who had a bare metal stent implanted (0.47 mm; SD, 0.69 mm; P<0.001). The rate of the composite end point of cardiac death, recurrent myocardial infarction, and target lesion revascularization was 8.6% in the DES group versus 14.4% in the bare metal stent group (P=0.03). Cardiac death occurred in 4.2% and 1.6% of the patients (P=0.09) and stent thrombosis occurred in 2.0% and 2.6% (P=0.72), respectively. CONCLUSIONS: Implantation of DES improves the angiographic outcome and need for repeat revascularization without increasing the short-term risk of stent thrombosis but has a tendency to increase cardiac death in patients with ST-segment-elevation myocardial infarction.

AB - BACKGROUND: Implantation of drug-eluting stents (DES) limits the rate of coronary restenosis in most patients with coronary artery disease, but data are scarce with regard to their use in patients with ST-segment-elevation myocardial infarction and in connection with distal protection of the microvascular perfusion during primary percutaneous coronary intervention. METHODS AND RESULTS: We randomly assigned 626 patients referred within 12 hours from symptom onset of an ST-elevation myocardial infarction to have a DES or a bare metal stent implanted in the infarct-related lesion with or without distal protection during primary percutaneous coronary intervention. Quantitative coronary angiography was performed during the index treatment and 8 months later. The primary end point was loss of the lumen diameter in the infarct-related lesion induced by neointimal proliferation. Patients were comparable with regard to baseline demographic and angiographic characteristics. The mean late lumen loss was significantly lower in patients treated with a DES (0.06 mm; SD, 0.66 mm) than in patients who had a bare metal stent implanted (0.47 mm; SD, 0.69 mm; P<0.001). The rate of the composite end point of cardiac death, recurrent myocardial infarction, and target lesion revascularization was 8.6% in the DES group versus 14.4% in the bare metal stent group (P=0.03). Cardiac death occurred in 4.2% and 1.6% of the patients (P=0.09) and stent thrombosis occurred in 2.0% and 2.6% (P=0.72), respectively. CONCLUSIONS: Implantation of DES improves the angiographic outcome and need for repeat revascularization without increasing the short-term risk of stent thrombosis but has a tendency to increase cardiac death in patients with ST-segment-elevation myocardial infarction.

U2 - 10.1161/CIRCULATIONAHA.107.758698

DO - 10.1161/CIRCULATIONAHA.107.758698

M3 - Journal article

C2 - 18725489

VL - 118

SP - 1155

EP - 1162

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 11

ER -