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Comparison of long-term outcomes in STEMI and NSTE-ACS after coronary stent placement: an analysis in a real world BMS and DES population.
Int J Cardiol 2013; 167(5):2082-7IJ

Abstract

BACKGROUND/OBJECTIVES

The prognostic difference between STEMI and NSTE-ACS after coronary stent placement remains unclear. We aimed to compare the short- and long-term event rates in patients presenting with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI) with either bare-metal stents (BMS) or drug-eluting stents (DES).

METHODS

Between 2000 and 2005 a total of 1749 STEMI and 1921 NSTE-ACS patients received either a BMS or DES in consecutive real world cohorts. Descriptive statistics and multivariate survival analyses were applied to compare the event rates in STEMI and NSTE-ACS during 4 years follow-up.

RESULTS

NSTE-ACS patients had significantly higher clinical and angiographic risk profiles at baseline and were treated with less optimal medical therapy during follow-up. At 4 years follow-up, all-cause mortality was significantly higher in STEMI compared to NSTE-ACS after coronary stent placement (17.4% vs. 14.3%; HR 1.60, 95% CI 1.24-2.07). In a landmark analysis no difference was seen in all-cause mortality among STEMI en NSTE-ACS between 1 month and 4 years follow-up (HR 1.10, 95% CI 0.81-1.51). Cardiac death was more prevalent in STEMI patients, while the 4-year cumulative incidences of any myocardial infarction, any coronary revascularization, target lesion revascularization and definite stent thrombosis were similar in both ACS groups.

CONCLUSIONS

Patients presenting with STEMI have a worse long-term prognosis compared to NSTE-ACS after coronary stent placement, due to higher short-term death rates. However, after the first month STEMI and NSTE-ACS patients have a comparable long-term survival.

Authors+Show Affiliations

Department of Cardiology, Erasmus MC, Thoraxcenter, Rotterdam, the Netherlands. m.a.h.vanleeuwen@erasmusmc.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22664371

Citation

van Leeuwen, Maarten A H., et al. "Comparison of Long-term Outcomes in STEMI and NSTE-ACS After Coronary Stent Placement: an Analysis in a Real World BMS and DES Population." International Journal of Cardiology, vol. 167, no. 5, 2013, pp. 2082-7.
van Leeuwen MA, Daemen J, van Mieghem NM, et al. Comparison of long-term outcomes in STEMI and NSTE-ACS after coronary stent placement: an analysis in a real world BMS and DES population. Int J Cardiol. 2013;167(5):2082-7.
van Leeuwen, M. A., Daemen, J., van Mieghem, N. M., de Boer, S. P., Boersma, E., van Geuns, R. J., ... Serruys, P. W. (2013). Comparison of long-term outcomes in STEMI and NSTE-ACS after coronary stent placement: an analysis in a real world BMS and DES population. International Journal of Cardiology, 167(5), pp. 2082-7. doi:10.1016/j.ijcard.2012.05.064.
van Leeuwen MA, et al. Comparison of Long-term Outcomes in STEMI and NSTE-ACS After Coronary Stent Placement: an Analysis in a Real World BMS and DES Population. Int J Cardiol. 2013 Sep 1;167(5):2082-7. PubMed PMID: 22664371.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of long-term outcomes in STEMI and NSTE-ACS after coronary stent placement: an analysis in a real world BMS and DES population. AU - van Leeuwen,Maarten A H, AU - Daemen,Joost, AU - van Mieghem,Nicolas M, AU - de Boer,Sanneke P M, AU - Boersma,Eric, AU - van Geuns,Robert J, AU - Zijlstra,Felix, AU - van Domburg,Ron T, AU - Serruys,Patrick W J C, AU - ,, Y1 - 2012/06/02/ PY - 2012/04/01/received PY - 2012/05/12/accepted PY - 2012/6/6/entrez PY - 2012/6/6/pubmed PY - 2014/4/23/medline KW - NSTE-ACS KW - Outcome KW - PCI KW - STEMI KW - Stent SP - 2082 EP - 7 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 167 IS - 5 N2 - BACKGROUND/OBJECTIVES: The prognostic difference between STEMI and NSTE-ACS after coronary stent placement remains unclear. We aimed to compare the short- and long-term event rates in patients presenting with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI) with either bare-metal stents (BMS) or drug-eluting stents (DES). METHODS: Between 2000 and 2005 a total of 1749 STEMI and 1921 NSTE-ACS patients received either a BMS or DES in consecutive real world cohorts. Descriptive statistics and multivariate survival analyses were applied to compare the event rates in STEMI and NSTE-ACS during 4 years follow-up. RESULTS: NSTE-ACS patients had significantly higher clinical and angiographic risk profiles at baseline and were treated with less optimal medical therapy during follow-up. At 4 years follow-up, all-cause mortality was significantly higher in STEMI compared to NSTE-ACS after coronary stent placement (17.4% vs. 14.3%; HR 1.60, 95% CI 1.24-2.07). In a landmark analysis no difference was seen in all-cause mortality among STEMI en NSTE-ACS between 1 month and 4 years follow-up (HR 1.10, 95% CI 0.81-1.51). Cardiac death was more prevalent in STEMI patients, while the 4-year cumulative incidences of any myocardial infarction, any coronary revascularization, target lesion revascularization and definite stent thrombosis were similar in both ACS groups. CONCLUSIONS: Patients presenting with STEMI have a worse long-term prognosis compared to NSTE-ACS after coronary stent placement, due to higher short-term death rates. However, after the first month STEMI and NSTE-ACS patients have a comparable long-term survival. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/22664371/Comparison_of_long_term_outcomes_in_STEMI_and_NSTE_ACS_after_coronary_stent_placement:_an_analysis_in_a_real_world_BMS_and_DES_population_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(12)00678-X DB - PRIME DP - Unbound Medicine ER -