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J Am Coll Cardiol, 2004; 43:704-708, doi:10.1016/j.jacc.2003.12.022
© 2004 by the American College of Cardiology Foundation
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EXPRESS PUBLICATION

Short- and long-term clinical benefit of sirolimus-eluting stents compared to conventional bare stents for patients with acute myocardial infarction

Pedro A. Lemos, MD*, Francesco Saia, MD*, Sjoerd H. Hofma, MD*, Joost Daemen*, Andrew T. L. Ong, MBBS FRACP*, Chourmouzios A. Arampatzis, MD*, Angela Hoye, MBChB, MRCP*, Eugene McFadden, MBChB, FRCPI, FACC*, Georgios Sianos, MD, PhD*, Pieter C. Smits, MD, PhD*, Willem J. van der Giessen, MD, PhD*, Pim de Feyter, MD, PhD, FACC*, Ron T. van Domburg, PhD* and Patrick W. Serruys, MD, PhD, FACC*,*

* Erasmus Medical Center, Thoraxcenter, Rotterdam, Netherlands

Manuscript received November 4, 2003; revised manuscript received November 20, 2003, accepted November 24, 2003.

* Reprint requests and correspondence: Dr. Patrick W. Serruys, Thoraxcenter, Bd–406, Dr. Molewaterplein 40, 3015-GD Rotterdam, The Netherlands.
p.w.j.c.serruys{at}erasmusmc.nl

OBJECTIVES: This study investigated the clinical outcomes of patients with ST-segment elevation myocardial infarction (MI) treated with sirolimus-eluting stents (SESs) or with conventional bare stents.

BACKGROUND: The clinical impact of SES implantation for patients with ST-segment elevation MI is currently unknown.

METHODS: Primary angioplasty was performed with SESs in 186 consecutive patients with acute MI who were compared with 183 patients treated with bare stents. The incidence of death, reinfarction, and repeat revascularization was assessed at 30 and 300 days.

RESULTS: Postprocedure vessel patency, enzymatic release, and the incidence of short-term adverse events were similar in both the sirolimus and the bare stents (30-day rate of death, reinfarction, or repeat revascularization: 7.5% vs. 10.4%, respectively; p = 0.4). Stent thrombosis was not diagnosed in any patient in the sirolimus group and occurred in 1.6% of patients treated with bare stents (p = 0.1). At 300 days, treatment with SESs significantly reduced the incidence of combined adverse events (9.4% vs. 17%; hazard ratio [HR] 0.52 [95% confidence interval (CI) 0.30 to 0.92]; p = 0.02), mainly due to a marked reduction in the risk of repeat intervention (1.1% vs. 8.2%; HR 0.21 [95% CI 0.06 to 0.74]; p = 0.01).

CONCLUSIONS: Compared to conventional bare stents, the SESs were not associated with an increased risk of stent thrombosis and were effective in reducing the incidence of adverse events at 300 days in unselected patients with ST-segment elevation acute MI referred for primary angioplasty.

Abbreviations and Acronyms
  CI = confidence interval
  CK = creatine kinase
  HR = hazard ratio
  MI = myocardial infarction
  SES = sirolimus-eluting stent
  TIMI = Thrombolysis In Myocardial Infarction




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