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The efficacy and safety of drug-eluting stent (DES) in patients with ST-elevation myocardial infarction (STEMI) is previously studied. According to the previous studies, DES decreases target vessel revascularization (TVR) compared with bare-metal stent (BMS) and it could improve patient’s prognosis in long-term. However, evidences of a long-term prognostic effect of DES in patients with STEMI are limited.
In this study, we aimed to assess long-term prognosis after DES or BMS for patients with STEMI.
In this study, we chose patients with STEMI who treated by any of DES or BMS during the primary percutaneous coronary intervention (PCI). Patients with STEMI but do not receive any stent during primary PCI were excluded. The primary endpoint was all-cause mortality and the secondary endpoint was composite of recurrent myocardial infarction, revascularization, and heart failure. Cox proportional hazard regression and Kaplan-Meier survival estimation were used for long-term prognostic analysis.
A total of 541 patients with STEMI were initially selected and 52 patients didn’t receive any stent during primary PCI. Therefore, those 52 patients excluded and the final study population consisted of 489 patients. DES and BMS were implanted in 42 patients (8.6%) and 447 patients (91.4%), respectively. Baseline characteristics were differed between two groups. Median follow-up was 29.3 months (IQR 13.7; 42.6) for the primary endpoint and 14.3 months (IQR 4.9; 33.1) for secondary endpoint. Cox proportional hazard regression analysis revealed that DES didn’t associate with increased mortality (HR 0.53, 95% CI 0.13-2.20, p=0.384) compared with BMS. However, DES was associated with a trend toward decreased rate of the secondary endpoint (HR 0.51, 95% CI 0.26-1.0, p=0.051) compared with BMS. Furthermore, Kaplan-Meier survival curve analysis was confirmed those results.
The long-term mortality rate is comparable between DES and BMS in patients with STEMI. Compared with BMS, however, DES is associated with a trend toward a lower rate of recurrent myocardial infarction, revascularization, and heart failure.