FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 359:1330-1342 September 25, 2008 Number 13 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Studies comparing percutaneous coronary intervention (PCI) with drug-eluting and bare-metal coronary stents in acute myocardial infarction have been limited in size and duration.

Methods We identified all adults undergoing PCI with stenting for acute myocardial infarction between April 1, 2003, and September 30, 2004, at any acute care, nonfederal hospital in Massachusetts with the use of a state-mandated database of PCI procedures. We performed propensity-score matching on three groups of patients: all patients with acute myocardial infarction, all those with acute myocardial infarction with ST-segment elevation, and all those with acute myocardial infarction without ST-segment elevation. Propensity-score analyses were based on clinical, procedural, hospital, and insurance information collected at the time of the index procedure. Differences in the risk of death between patients receiving drug-eluting stents and those receiving bare-metal stents were determined from vital-statistics records.

Results A total of 7217 patients were treated for acute myocardial infarction (4016 with drug-eluting stents and 3201 with bare-metal stents). According to analysis of matched pairs, the 2-year, risk-adjusted mortality rates were lower for drug-eluting stents than for bare-metal stents among all patients with myocardial infarction (10.7% vs. 12.8%, P=0.02), among patients with myocardial infarction with ST-segment elevation (8.5% vs. 11.6%, P=0.008), and among patients with myocardial infarction without ST-segment elevation (12.8% vs. 15.6%, P=0.04). The 2-year, risk-adjusted rates of recurrent myocardial infarction were reduced in patients with myocardial infarction without ST-segment elevation who were treated with drug-eluting stents, and repeat revascularization rates were significantly reduced with the use of drug-eluting stents as compared with bare-metal stents in all groups.

Conclusions In patients presenting with acute myocardial infarction, treatment with drug-eluting stents is associated with decreased 2-year mortality rates and a reduction in the need for repeat revascularization procedures as compared with treatment with bare-metal stents.

Source Information

From Brigham and Women's Hospital (L.M., P.G., M.R.V., Z.Z.), the Harvard Clinical Research Institute (L.M.), Harvard Medical School (L.M., T.S.S., R.E.W., K.Z., A.L., S.-L.T.N.), and the Harvard School of Public Health (S.-L.T.N.) — all in Boston.

Address reprint requests to Dr. Mauri at Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, or at lmauri1{at}partners.org.

Full Text of this Article

Related Letters:

Drug-Eluting versus Bare-Metal Stents in Acute Myocardial Infarction
Wong B. Y.L., Kim D. H., Rothman K. J., Mauri L., Normand S.-L. T.
Extract | Full Text | PDF  
N Engl J Med 2009; 360:300-302, Jan 15, 2009. Correspondence

This article has been cited by other articles:

• Kushner, F. G., Hand, M., Smith, S. C. Jr, King, S. B. III, Anderson, J. L., Antman, E. M., Bailey, S. R., Bates, E. R., Blankenship, J. C., Casey, D. E. Jr, Green, L. A., Hochman, J. S., Jacobs, A. K., Krumholz, H. M., Morrison, D. A., Ornato, J. P., Pearle, D. L., Peterson, E. D., Sloan, M. A., Whitlow, P. L., Williams, D. O. (2009). 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 54: 2205-2241 [Full Text]  
• Corti, R., Toggweiler, S. (2009). PCI in acute left main disease: a paradigm shift or a new reality?. Eur Heart J 30: 2295-2296 [Full Text]  
• Obata, J.-e., Nakamura, T., Kitta, Y., Kodama, Y., Sano, K., Kawabata, K.-I., Saitoh, Y., Fujioka, D., Kobayashi, T., Yano, T., Watanabe, Y., Watanabe, K., Kugiyama, K. (2009). Treatment of Acute Myocardial Infarction With Sirolimus-Eluting Stents Results in Chronic Endothelial Dysfunction in the Infarct-Related Coronary Artery. Circ Cardiovasc Interv 2: 384-391 [Abstract] [Full Text]  
• Finn, A. V., Nakazawa, G., Kolodgie, F., Virmani, R. (2009). Drug eluting or bare metal stent for acute myocardial infarction: an issue of safety?. Eur Heart J 30: 1828-1830 [Full Text]  
• Dixon, S. R., Grines, C. L., O'Neill, W. W. (2009). The year in interventional cardiology.. J Am Coll Cardiol 53: 2080-2097 [Full Text]  
• Ko, D. T., Chiu, M., Guo, H., Austin, P. C., Goeree, R., Cohen, E., Labinaz, M., Tu, J. V. (2009). Safety and effectiveness of drug-eluting and bare-metal stents for patients with off- and on-label indications.. J Am Coll Cardiol 53: 1773-1782 [Abstract] [Full Text]  
• Stone, G. W., Lansky, A. J., Pocock, S. J., Gersh, B. J., Dangas, G., Wong, S. C., Witzenbichler, B., Guagliumi, G., Peruga, J. Z., Brodie, B. R., Dudek, D., Mockel, M., Ochala, A., Kellock, A., Parise, H., Mehran, R., the HORIZONS-AMI Trial Investigators, (2009). Paclitaxel-Eluting Stents versus Bare-Metal Stents in Acute Myocardial Infarction. NEJM 360: 1946-1959 [Abstract] [Full Text]  
• Brar, S. S., Leon, M. B., Stone, G. W., Mehran, R., Moses, J. W., Brar, S. K., Dangas, G. (2009). Use of drug-eluting stents in acute myocardial infarction: a systematic review and meta-analysis.. J Am Coll Cardiol 53: 1677-1689 [Abstract] [Full Text]  
• Messori, A, Trippoli, S (2009). Drug-eluting stents for the treatment of coronary artery disease: NICE technology appraisal guidance. Heart 95: 847-847 [Full Text]  
• Philpott, A. C. MD, Southern, D. A. MSc, Clement, F. M. PhD, Galbraith, P. D. BN MSc, Traboulsi, M. MD, Knudtson, M. L. MD, Ghali, W. A. MD, for the APPROACH Investigators, (2009). Long-term outcomes of patients receiving drug-eluting stents. CMAJ 180: 167-174 [Abstract] [Full Text]  
• Genereux, P. MD, Mehran, R. MD (2009). Are drug-eluting stents safe in the long term?. CMAJ 180: 154-155 [Full Text]  
• Wong, B. Y.L., Kim, D. H., Rothman, K. J., Mauri, L., Normand, S.-L. T. (2009). Drug-eluting versus bare-metal stents in acute myocardial infarction.. NEJM 360: 300-301 [Full Text]  
• Mauri, L., Silbaugh, T. S., Wolf, R. E., Zelevinsky, K., Lovett, A., Zhou, Z., Resnic, F. S., Normand, S.-L. T. (2008). Long-Term Clinical Outcomes After Drug-Eluting and Bare-Metal Stenting in Massachusetts. Circulation 118: 1817-1827 [Abstract] [Full Text]  
• (2008). Drug-Eluting Stents Beat Bare-Metal Stents in Acute MI Analysis. Journal Watch Cardiology 2008: 2-2 [Full Text]  
• Bates, E. R. (2008). Primary Percutaneous Coronary Intervention With Drug-Eluting Stents: Another Chapter in the Stent Controversy. Circ Cardiovasc Interv 1: 87-89 [Full Text]  
• (2008). All you need to read in the other general journals. BMJ 337: a1854-a1854 [Full Text]