One year clinical follow-up of paclitaxel-eluting stents for acute myocardial infarction compared to sirolimus-eluting stents

Sjoerd H Hofma ¹, Andrew TL Ong ¹, Jiro Aoki ¹, Carlos AG van Mieghem ¹, G A Rodriguez Granillo ¹, Marco Valgimigli ¹, Evelyn Regar ¹, Peter PT de Jaegere ¹, Eugene P McFadden ¹, Georgios Sianos ¹, Wim J van der Giessen ¹, Pim J de Feyter ¹, Ron T Van Domburg ¹ and Patrick W Serruys ^1*

¹ EMCR, Netherlands

^* To whom correspondence should be addressed. E-mail: p.w.j.c.serruys{at}erasmusmc.nl.

Accepted 29 April 2005

Abstract

Objective: Comparison of clinical outcome of paclitaxel-eluting stents (PES) versus sirolimus-eluting stents (SES) for the treatment of acute ST-elevation myocardial infarction.

Design and patients: The first 136 consecutive patients treated exclusively with PES, in the setting of primary percutaneous coronary intervention for acute myocardial infarction in our single centre registry were prospectively clinically assessed at 30 days and 1 year follow-up and compared with 186 consecutive patients treated exclusively with SES, in the preceding period.

Setting: Academic tertiary referral centre.

Results: At 30 days, all-cause mortality and or re-infarction was similar between groups (6.5% vs. 6.6% for SES and PES respectively, p=1.0). A significant difference in target vessel revascularisation (TVR) was seen in favour of SES (1.1% vs. 5.1% for PES, p=0.04). This was driven by stent thrombosis (n=4), especially in bifurcation stenting (n=2). At one year, no significant differences were seen between groups, with no late thrombosis and 1.5% in-stent restenosis (needing TVR) in PES, versus no re-interventions in SES (p=0.2). One-year survival free of major cardiac events (MACE) was 90.2% for SES and 85% for PES (p = 0.16).

Conclusions: No significant differences were seen in MACE-free survival at one year between SES and PES for the treatment of acute myocardial infarction with very low rates of reintervention for restenosis. Bifurcation stenting in acute myocardial infarction should, if possible, be avoided due to the increased risk of stent thrombosis.

Keywords: drug-eluting, myocardial infarction, stents

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