Sirolimus-Eluting versus Uncoated Stents in Acute Myocardial Infarction

Spaulding, Christian; Henry, Patrick; Teiger, Emmanuel; Beatt, Kevin J.; Bramucci, Ezio; Carrié, Didier; Slama, Michel; Merkely, Béla; Ērglis, Andrejs; Margheri, Massimo; Varenne, Olivier; Cebrián, Ana; Stoll, Hans Peter; Snead, D.; Bode, Christoph

doi:10.1056/nejmoa062006

Cited by 526 publications

(355 citation statements)

References 18 publications

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“…Clinical results after PCI with first-generation SES have been reported in many large randomized controlled trials, clinical registries, and small single-center series (Table III, Supporting Information Appendix) [10][11][12][13]. Our data confirm the safety and efficacy of PCI using first-generation SES, extending previous observations in a very large consecutive and unselected cohort of DM patients.…”

Section: Discussionsupporting

confidence: 80%

One‐year clinical outcomes after sirolimus‐eluting coronary stent implantation in diabetics enrolled in the worldwide e‐SELECT registry

Bartorelli

Assenza

Abizaid

et al. 2015

Cathet Cardio Intervent

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BackgroundDiabetes mellitus has worse outcome after percutaneous coronary intervention.AimWe assessed stent thrombosis (ST), major adverse cardiac events (MACE), and major bleeding rates at 1 year after implantation of sirolimus‐eluting stents (SES) in patients with diabetes mellitus in a large multicenter registry.MethodsFrom May 2006 to April 2008, 15,147 unselected consecutive patients were enrolled at 320 centers in 56 countries in a prospective, observational registry after implantation of ≥ 1 SES. Source data were verified in 20% randomly chosen patients at > 100 sites. Adverse events were adjudicated by an independent Clinical Event Committee.ResultsComplete follow‐up at 1 year was obtained in 13,693 (92%) patients, 4,577 (30%) of whom were diabetics. Within diabetics, 1,238 (9%) were insulin‐treated diabetics (ITD). Diabetics were older (64 vs. 62 years, P < 0.001), with higher incidence of major coronary risk factors, co‐morbidities, and triple‐vessel coronary artery disease. Coronary lesions had smaller reference vessel diameter (2.88 ± 0.46 vs. 2.93 ± 0.45 mm, P < 0.001) and were more often heavily calcified (26.1% vs. 22.6%, P < 0.001). At 1 year, diabetics had higher MACE rate (6.8% vs. 3.9%, P < 0.001) driven by ITD (10.6% vs. 5.5%, P < 0.001). Finally, diabetics had significant increase in ST (1.7% vs. 0.7%, P < 0.001), principally owing to ITD (3.4% vs. 1.1%, P < 0.001). There was an overall low risk of major bleeding during follow‐up, without significant difference among subgroups.ConclusionsIn the e‐SELECT registry, diabetics represented 30% of patients undergoing SES implantation and had significantly more co‐morbidities and complex coronary lesions. Although 1‐year follow‐up documented good overall outcome in diabetics, higher ST and MACE rates were observed, mainly driven by ITD. © 2015 Wiley Periodicals, Inc.

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Section: Discussionsupporting

confidence: 80%

One‐year clinical outcomes after sirolimus‐eluting coronary stent implantation in diabetics enrolled in the worldwide e‐SELECT registry

Bartorelli

Assenza

Abizaid

et al. 2015

Cathet Cardio Intervent

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“…17 During 42 d follow-up after procedure, 10 (7.9%) patients died. Their mortality rate was somewhat higher than expected from current data 18,19 and was 2.0-fold higher compared with 1-y death from our data (3.9%). Therefore, we thought that their results might not reflect real-world practices, especially in the DES era.…”

Section: Discussioncontrasting

confidence: 77%

Biomarkers on Admission for the Prediction of Cardiovascular Events After Primary Stenting in Patients with ST‐Elevation Myocardial Infarction

Jeong

Lee

et al. 2008

Clinical Cardiology

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Background: Several cardiac biomarkers have been shown to have predictive values for the development of cardiovascular disease and clinical outcome after events, and are now broadly used by clinicians. Little is known about the utility of these biomarker values on admission in ST-elevation myocardial infarction (STEMI) cases of primary drug-eluting stent (DES) implantation and intense medical therapy. Hypothesis: Because little is known about the utility of these biomarkers on admission in ST-elevation myocardial infarction (STEMI) in cases primary drug-eluting stent (DES) implantation and intense medical therapy, we evaluated clinical outcomes. Methods: We enrolled 207 consecutive STEMI patients treated with primary stenting (mean age, 57.3±12.0 y). We evaluated the association between B-type natriuretic peptide (BNP), cardiac troponin I (cTnI), highsensitivity C-reactive protein (hs-CRP) on admission, and death, reinfarction, and new or worsening congestive heart failure (CHF) through 1 y. Results: In backward-elimination models including all biomarkers, only the cTnI level was retained as a predictor of 1-y CHF (odds ratio [OR]: 1.017, 95% confidence interval [CI]: 1.001-1.034, p = 0.039). There were no predictors in terms of 1-y death, reinfarction, and composite endpoint. When we applied a simple score system, in which patients were categorized on the basis of the number of elevated biomarkers, the 1-y risks of death (p = 0.600), reinfarction (p = 0.185), and composite endpoint (p = 0.620) did not increase in proportion to the number of elevated biomarkers on admission. One-y CHF only tended to increase according to the number of elevated biomarkers (p = 0.067). Conclusions:The use of cardiac biomarkers on admission, in each or in combination, had only a minimal impact for the prediction of long-term cardiovascular events after primary stenting in STEMI patients.

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“…2 In this clinical setting, fi rst-generation drug-eluting stents (DES) reduced clinical and angiographic restenosis, compared with bare-metal stents (BMS). [3][4][5][6][7] Conversely, these benefi ts were counterbalanced by an increased risk of very late stent thrombosis, [8][9][10][11] safety concerns that were confi rmed on autopsy, and intravascular imaging studies showing evidence of incomplete endothelialisation, delayed arterial healing, and vessel remodelling because of chronic infl ammation. [12][13][14][15] The development of neotherosclerosis, 16 which might occur earlier after DES than after BMS, 17 has also been identifi ed as a potential cause.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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.

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Sirolimus-Eluting versus Uncoated Stents in Acute Myocardial Infarction

Cited by 526 publications

References 18 publications

One‐year clinical outcomes after sirolimus‐eluting coronary stent implantation in diabetics enrolled in the worldwide e‐SELECT registry

One‐year clinical outcomes after sirolimus‐eluting coronary stent implantation in diabetics enrolled in the worldwide e‐SELECT registry

Biomarkers on Admission for the Prediction of Cardiovascular Events After Primary Stenting in Patients with ST‐Elevation Myocardial Infarction

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

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