Selective use of contemporary drug-eluting stents in primary angioplasty for ST-elevation myocardial infarction: Pooled analysis of COMFORTABLE AMI and EXAMINATION
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Selective use of contemporary drug-eluting stents in primary angioplasty for ST-elevation myocardial infarction : Pooled analysis of COMFORTABLE AMI and EXAMINATION. / Baumbach, Andreas; Heg, Dik; Räber, Lorenz; Ostoijc, Miodrag; Brugaletta, Salvatore; Strange, Julian W.; Johnson, Thomas W.; Jüni, Peter; Engstrøm, Thomas; Serruys, Patrick W.; Sabaté, Manel; Windecker, Stephan.
I: EuroIntervention, Bind 12, Nr. 13, 01.2017, s. 1577-1586.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Selective use of contemporary drug-eluting stents in primary angioplasty for ST-elevation myocardial infarction
T2 - Pooled analysis of COMFORTABLE AMI and EXAMINATION
AU - Baumbach, Andreas
AU - Heg, Dik
AU - Räber, Lorenz
AU - Ostoijc, Miodrag
AU - Brugaletta, Salvatore
AU - Strange, Julian W.
AU - Johnson, Thomas W.
AU - Jüni, Peter
AU - Engstrøm, Thomas
AU - Serruys, Patrick W.
AU - Sabaté, Manel
AU - Windecker, Stephan
PY - 2017/1
Y1 - 2017/1
N2 - Aims: Selective use of DES only in patients at higher risk of MACE is common practice, particularly in healthcare systems with a large premium payable for DES. We aimed to identify subgroups of patients in which the use of BMS in primary percutaneous coronary intervention (PPCI) for STEMI can still be justified. Methods and results: We performed a patient-level pooled analysis of COMFORTABLE AMI and EXAMINATION comparing contemporary DES with BMS in PPCI. A risk score was applied using three parameters: lesion length >15mm, vessel size <3 mm, and diabetes mellitus. Individual data were available for 2,655 patients. The incidence of MACE at one year was incrementally higher in patients with risk scores of 1 or 2/3. MACE rates were lower in patients with a risk score 0 or 1 who were treated with DES (p=0.0073 and p=0.008). No difference in death or reinfarction was seen between DES and BMS in any group. There was a significant reduction in TLR with DES in all three groups. Conclusions: A score comprising vessel size, lesion length, and diabetes did not identify patients at low risk with equivalent or better results from BMS use. The results suggest that the practice of only selective use of DES in primary PCI should be discouraged.
AB - Aims: Selective use of DES only in patients at higher risk of MACE is common practice, particularly in healthcare systems with a large premium payable for DES. We aimed to identify subgroups of patients in which the use of BMS in primary percutaneous coronary intervention (PPCI) for STEMI can still be justified. Methods and results: We performed a patient-level pooled analysis of COMFORTABLE AMI and EXAMINATION comparing contemporary DES with BMS in PPCI. A risk score was applied using three parameters: lesion length >15mm, vessel size <3 mm, and diabetes mellitus. Individual data were available for 2,655 patients. The incidence of MACE at one year was incrementally higher in patients with risk scores of 1 or 2/3. MACE rates were lower in patients with a risk score 0 or 1 who were treated with DES (p=0.0073 and p=0.008). No difference in death or reinfarction was seen between DES and BMS in any group. There was a significant reduction in TLR with DES in all three groups. Conclusions: A score comprising vessel size, lesion length, and diabetes did not identify patients at low risk with equivalent or better results from BMS use. The results suggest that the practice of only selective use of DES in primary PCI should be discouraged.
U2 - 10.4244/EIJ-D-15-00408
DO - 10.4244/EIJ-D-15-00408
M3 - Journal article
C2 - 27998831
AN - SCOPUS:85016038840
VL - 12
SP - 1577
EP - 1586
JO - EuroIntervention
JF - EuroIntervention
SN - 1774-024X
IS - 13
ER -
ID: 196469809