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Drug-Eluting Stents for ST-Segment Elevation MI?

Two studies suggest that, during the first year after stenting, patients who receive drug-eluting stents fare at least as well as those who receive bare metal stents.

Although drug-eluting stents (DES) are often used when performing percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI), data comparing outcomes with DES and bare-metal stents (BMS) in this setting are limited. Now, two European groups report their experiences.

In one study, 619 patients with STEMI were randomized to receive a paclitaxel DES or one of two BMS. At 1 year, a trend was noted toward lower rates of the primary endpoint (death from cardiac causes, recurrent MI, or revascularization of the target lesion) in the DES group (8.8% vs. 12.8%; P=0.09). The incidence of stent thrombosis was the same in the two groups (1.0%).

In the other study, supported by a sirolimus DES manufacturer, 712 patients with STEMI who met certain angiographic criteria were randomized to receive a sirolimus DES or any form of BMS. The rate of the primary endpoint (target-vessel–related death, recurrent MI, or target-vessel revascularization) was significantly lower in the DES group (7.3% vs. 14.3%), due mostly to less frequent revascularization. Rates of death, MI, and stent thrombosis were similar in the two groups.

Comment: Taken together, these data suggest that patients with STEMI who undergo PCI with drug-eluting stents fare at least as well — and probably better — during the first year than those who receive bare metal stents. An editorialist cautions that the studies did not directly compare the efficacy of paclitaxel versus sirolimus-eluting stents. Also, because follow-up was limited to 1 year, the findings do not fully address recent concerns that drug-eluting stents are more prone to late stent thrombosis than bare-metal stents.

— Kirsten E. Fleischmann, MD, MPH

Published in Journal Watch General Medicine October 19, 2006

Citation(s):

Laarman GJ et al. Paclitaxel-eluting versus uncoated stents in primary percutaneous coronary intervention. N Engl J Med 2006 Sep 14; 355:1105-13.

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• Medline abstract (Free)

Spaulding C et al. Sirolimus-eluting versus uncoated stents in acute myocardial infarction. N Engl J Med 2006 Sep 14; 355:1093-104.

• Original article (Subscription may be required)
• Medline abstract (Free)

Van de Werf F. Drug-eluting stents in acute myocardial infarction. N Engl J Med 2006 Sep 14; 355:1169-70.

• Original article (Subscription may be required)
• Medline abstract (Free)