Comparison of Six-Month Outcomes for Primary Percutaneous Revascularization for Acute Myocardial Infarction With Drug-Eluting Versus Bare Metal Stents (from the APEX-AMI Study)

Manesh R. Patel, Matthias E. Pfisterer, Amadeo Betriu, Petr Widmisky, David Holmes, William W. O'Neill, Amanda Stebbins, Frans Van de Werf, Paul W. Armstrong, Christopher B. Granger

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Abstract

We evaluated the use and outcomes of drug-eluting stents (DESs) and bare metal stents (BMSs) in a large primary percutaneous coronary intervention (PCI) acute ST-elevation myocardial infarction (MI) trial. Recently concerns have been raised with "off-label" use of DESs for short- and long-term clinical outcomes. Limited randomized data exist evaluating DESs versus BMSs in ST-elevation MI. Patients (n = 5,745) in the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial were categorized by stent type used. Baseline variables and clinical outcomes were collected at 90 days and 6 months. Outcomes by stent type were adjusted for using conventional multivariable predictors of 90-day mortality (age, anterior location, total ST-segment deviation, and Killip class), time to PCI, and Thrombolysis In Myocardial Infarction grade flow. Stents were deployed (at the investigator's discretion) in 5,124 patients (89.2%) with acute MI, with DES use in 2,221 (43.3%) and BMS use in 2,903 (56.7%). Patients receiving DESs were younger (median 59 vs 63 years of age, p <0.001), had left anterior descending coronary artery PCI (57.9% vs 48.1%, p <0.001), and often were treated in the United States (58.2%). DES-treated patients had a lower adjusted mortality at 90 days (hazard ratio 0.73, 95% confidence interval [CI] 0.54 to 0.99, p = 0.046) and trended toward lower mortality (hazard ratio 0.77, 95% CI 0.58 to 1.03, p = 0.084) and recurrent MI (hazard ratio 0.81, 95% CI 0.59 to 1.11, p = 0.186) at 6 months compared with BMSs. In conclusion, in this observational analysis of stent use from a large primary percutaneous intervention for acute MI trial, DESs appear as safe as BMSs with similar 6-month clinical outcomes with regard to death and recurrent MI.

Original languageEnglish (US)
Pages (from-to)181-186
Number of pages6
JournalAmerican Journal of Cardiology
Volume103
Issue number2
DOIs
StatePublished - Jan 15 2009

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Drug-Eluting Stents
Stents
Metals
Myocardial Infarction
Pharmaceutical Preparations
Percutaneous Coronary Intervention
Confidence Intervals
Mortality
Off-Label Use
pexelizumab
Coronary Vessels
Research Personnel

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of Six-Month Outcomes for Primary Percutaneous Revascularization for Acute Myocardial Infarction With Drug-Eluting Versus Bare Metal Stents (from the APEX-AMI Study). / Patel, Manesh R.; Pfisterer, Matthias E.; Betriu, Amadeo; Widmisky, Petr; Holmes, David; O'Neill, William W.; Stebbins, Amanda; Van de Werf, Frans; Armstrong, Paul W.; Granger, Christopher B.

In: American Journal of Cardiology, Vol. 103, No. 2, 15.01.2009, p. 181-186.

Research output: Contribution to journalArticle

Patel, Manesh R. ; Pfisterer, Matthias E. ; Betriu, Amadeo ; Widmisky, Petr ; Holmes, David ; O'Neill, William W. ; Stebbins, Amanda ; Van de Werf, Frans ; Armstrong, Paul W. ; Granger, Christopher B. / Comparison of Six-Month Outcomes for Primary Percutaneous Revascularization for Acute Myocardial Infarction With Drug-Eluting Versus Bare Metal Stents (from the APEX-AMI Study). In: American Journal of Cardiology. 2009 ; Vol. 103, No. 2. pp. 181-186.
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abstract = "We evaluated the use and outcomes of drug-eluting stents (DESs) and bare metal stents (BMSs) in a large primary percutaneous coronary intervention (PCI) acute ST-elevation myocardial infarction (MI) trial. Recently concerns have been raised with {"}off-label{"} use of DESs for short- and long-term clinical outcomes. Limited randomized data exist evaluating DESs versus BMSs in ST-elevation MI. Patients (n = 5,745) in the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial were categorized by stent type used. Baseline variables and clinical outcomes were collected at 90 days and 6 months. Outcomes by stent type were adjusted for using conventional multivariable predictors of 90-day mortality (age, anterior location, total ST-segment deviation, and Killip class), time to PCI, and Thrombolysis In Myocardial Infarction grade flow. Stents were deployed (at the investigator's discretion) in 5,124 patients (89.2{\%}) with acute MI, with DES use in 2,221 (43.3{\%}) and BMS use in 2,903 (56.7{\%}). Patients receiving DESs were younger (median 59 vs 63 years of age, p <0.001), had left anterior descending coronary artery PCI (57.9{\%} vs 48.1{\%}, p <0.001), and often were treated in the United States (58.2{\%}). DES-treated patients had a lower adjusted mortality at 90 days (hazard ratio 0.73, 95{\%} confidence interval [CI] 0.54 to 0.99, p = 0.046) and trended toward lower mortality (hazard ratio 0.77, 95{\%} CI 0.58 to 1.03, p = 0.084) and recurrent MI (hazard ratio 0.81, 95{\%} CI 0.59 to 1.11, p = 0.186) at 6 months compared with BMSs. In conclusion, in this observational analysis of stent use from a large primary percutaneous intervention for acute MI trial, DESs appear as safe as BMSs with similar 6-month clinical outcomes with regard to death and recurrent MI.",
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AU - Pfisterer, Matthias E.

AU - Betriu, Amadeo

AU - Widmisky, Petr

AU - Holmes, David

AU - O'Neill, William W.

AU - Stebbins, Amanda

AU - Van de Werf, Frans

AU - Armstrong, Paul W.

AU - Granger, Christopher B.

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