Clinical outcomes in patients with ST-segment elevation myocardial infarction treated with everolimus-eluting stents versus bare-metal stents (EXAMINATION): 5-year results of a randomised trial

Abstract

SummaryBackground Data for the safety and effi cacy of new-generation drug-eluting stents at long-term follow-up, and specifi cally in patients with ST-segment elevation myocardial infarction, are scarce. In the EXAMINATION trial, we compared everolimus-eluting stents (EES) with bare-metal stents (BMS) in an all-comer population with ST-segment elevation myocardial infarction. In this study, we assessed the 5-year outcomes of the population in the EXAMINATION trial.

Bioresorbable vascular scaffolds in patients with acute myocardial infarction: a new step forward to optimized reperfusion?

“…In this study EES also significantly reduced the rates of target-lesion revascularization (7). Moreover, the 5-year results of this randomized trial (8) confirmed that the sustained clinical efficacy of EES in STEMI patients may translate into a survival improvement.…”

2018 ESC/EACTS Guidelines on myocardial revascularization

“…In patients with STEMI, DES (in particular new-generation DES) have demonstrated better efficacy as compared with BMS and should be used as the default strategy in STEMI patients, even when DAPT cannot be sustained beyond 1 month. 177,178,[216][217][218] (see section 16.1.2). As discussed in section 16.4, radial access is preferred over femoral access.…”

Drug-eluting stents versus bare-metal stents in acute myocardial infarction with cardiogenic shock

“…In addition, increasing age was associated with BMS use in the present trial which is also seen elsewhere in the literature. The age-dependent selection of stent type is probably reasoned by the results of the COMFORTABLE AMI and EXAMINATION trial which did not show superiority of DES over BMS in patients>65 years19 and >75 years,3 respectively. Single vessel disease predicting BMS use in the present analysis is probably explainable by the higher risk for restenosis with BMS 3 19.…”

“…Mainly based on the long-term data of the Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction (COMFORTABLE AMI)2 and Everolimus-Eluting Stents Versus Bare-Metal Stents in ST-Segment Elevation Myocardial Infarction (EXAMINATION) trials,3 current European guidelines recommend the use of drug-eluting stents (DES) over bare-metal stents (BMS) in AMI regardless of presentation with ST-elevation or non-ST-elevation infarction 4. In contrast, current US guidelines do not recommend a preference for DES in AMI 5 6…”