Long-term outcomes of intravascular ultrasound-guided implantation of bare metal stents versus drug-eluting stents in primary percutaneous coronary intervention.
10.3904/kjim.2014.29.1.66
- Author:
Yun Kyeong CHO
1
;
Seung Ho HUR
;
Nam Hee PARK
;
Sang Woong CHOI
;
Ji Hyun SOHN
;
Hyun Ok CHO
;
Hyoung Seob PARK
;
Hyuck Jun YOON
;
Hyungseop KIM
;
Chang Wook NAM
;
Yoon Nyun KIM
;
Kwon Bae KIM
Author Information
1. Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea. shur@dsmc.or.kr
- Publication Type:Original Article ; Comparative Study
- Keywords:
Ultrasonography, interventional;
Myocardial infarction;
Drug-eluting stents
- MeSH:
Aged;
Drug-Eluting Stents/*statistics & numerical data;
Female;
Follow-Up Studies;
Humans;
Male;
Middle Aged;
Myocardial Infarction/mortality/*surgery;
Percutaneous Coronary Intervention/*instrumentation/statistics & numerical data;
Reoperation/statistics & numerical data;
Republic of Korea/epidemiology;
Retrospective Studies;
Treatment Outcome;
*Ultrasonography, Interventional
- From:The Korean Journal of Internal Medicine
2014;29(1):66-75
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: While drug-eluting stents (DESs) have shown favorable outcomes in ST-segment elevation myocardial infarction (STEMI) compared to bare metal stents (BMSs), there are concerns about the risk of stent thrombosis (ST) with DESs. Because intravascular ultrasound (IVUS) guidance may help optimize stent placement and improve outcomes in percutaneous coronary intervention (PCI) patients, we evaluated the impact of IVUS-guided BMS versus DES implantation on long-term outcomes in primary PCI. METHODS: In all, 239 STEMI patients received DES (n = 172) or BMS (n = 67) under IVUS guidance in primary PCI. The 3-year incidence of major adverse cardiac events (MACEs) including death, myocardial infarction (MI), target vessel revascularization (TVR), and ST was evaluated. RESULTS: There was no difference in all cause mortality or MI. However, the incidence of TVR was 23.9% with BMS versus 9.3% with DES (p = 0.005). Thus, the number of MACEs was significantly lower with DES (11.0% vs. 29.9%; p = 0.001). The incidence of definite or probable ST was not different (1.5% vs. 2.3%; p = 1.0). IVUS-guided DES implantation (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.08 to 0.78; p = 0.017), stent length (HR, 1.03; 95% CI, 1.00 to 1.06; p = 0.046), and multivessel disease (HR, 3.01; 95% CI, 1.11 to 8.15; p = 0.030) were independent predictors of MACE. CONCLUSIONS: In patients treated with primary PCI under IVUS guidance, the use of DES reduced the incidence of 3-year TVR versus BMS. However, all cause mortality and MI were similar between the groups. The incidence of ST was low in both groups.
