Drug eluting or bare metal stent for acute myocardial infarction: an issue of safety?

Background: The present study was conducted with the aim of determining whether drug-elutingstents are superior to uncoated stents in the setting of primaryPCI in terms of occurrence of serious adverse cardiac events.Methods: In this prospective, single blind, randomized study, 20 to 80 years old patients with acute myocardial infarction with ST-segment elevation with >30 minutes of chest pain and at least 1 mm of ST-segment elevation in at least two standard leads or a new LBBB or 2 mm of ST-segment elevation in at least two contiguous leads were included. Patients were randomly assigned to receive either drug eluting stent (DES) (Everolimus Eluting stent, Endevour-Medtronics) or bare metal stent (BMS, Cordis-Dx sonic) in a 1:1 ratio. During follow ups at 30 days and 12 months, all serious adverse cardiac events like death from cardiac or non-cardiac cause, recurrent MI, revascularization of target vessel, coronary artery bypass grafting (CABG) or other intervention to target or non-target vessel etc. were recorded and compared between groups.Results: No significant differences were found between the two treatmentgroups for occurrence of adverse events during first 30 days after the intervention. At one year follow-up, trends were observed in favorof the DES group, none of the differences weresignificant.Conclusions: No significant benefit was observed with the use of Everolimus-eluting stents in primaryPCI for acute myocardial infarction with ST-segment elevation,in comparison with baremetal stents.

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Abstract 4913: Difference of not only Magnitude but also Heterogeneity of Neointimal Coverage between Drug-Eluting Stent and Bare Metal Stent in Acute Myocardial Infarction

Circulation ◽

10.1161/circ.118.suppl_18.s_959 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Masami Nishino ◽

Takahiro Yoshimura ◽

Yasuharu Lee ◽

Daisuke Nakamura ◽

Shinpei Nakatani ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Density Lipoprotein ◽

Bare Metal Stent ◽

Drug Eluting Stent ◽

Bare Metal ◽

Metal Stent ◽

Drug Eluting ◽

Neointimal Coverage ◽

Lower Magnitude

Drug-eluting stent (DES) achieved significant reduced restenosis, however the safety of efficacy of DES in acute myocardial infarction (AMI) are still controversial. In this study, we compared angioscopic parameters between DES and bare metal stent (BMS) in patients with AMI. Eighty-seven consecutive patients who received DES or BMS for AMI were enrolled. At 6-month after AMI, coronary angiography was performed in all patients. We performed coronay angioscope (CAS) if the patients did not show significant in-stent restenosis (>50% stenosis). Using CAS, we evaluated the maximum and minimum grade of neointimal coverage within one stent using the following CAS score: 0: stent struts were exposed similary to right implantaiton, 1: stent were covered by very thin neointima, 2: struts were embedded but visible and 3: struts were fully embedded and invisible. We adopted minimium grade as the magnitude of neointimal coverage and calculated heterogeneity score as the following formula: (maximum grade) − (minimum grade). We compared CAS parameters including magnitude and heterogeneity score of neointimal coverage, visible thrombi and plaque color (white or yellow) aroud stent, and serum parameters including low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, hemoglobin A1c and high sensitive C-reactive protein (hs-CRP). Restnosis rate of DES (n=56) was significantly lower than that of BMS (n=31): 9% vs. 29%, p=0.03. In patients without restenosis, DES group revealed lower magnitude and higher heterogeneity score as compared to BMS group while there were no significant differences of the other parameters between the two groups (table ). Not only lower magnitude but also more heterogeneous propery of neointimal coverage were shown in DES as compared to in BMS at 6-month after AMI. These findings may be correlated with future cardiac evetns while restenosis rate is lower in DES than in BMS.

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