Tags

Type your tag names separated by a space and hit enter

Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: 5 years follow-up from the randomized DEDICATION trial (Drug Elution and Distal Protection in Acute Myocardial Infarction).
JACC Cardiovasc Interv. 2013 Jun; 6(6):548-53.JC

Abstract

OBJECTIVES

This study sought to compare the long-term effects of drug-eluting stent (DES) compared with bare-metal stent (BMS) implantation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention.

BACKGROUND

The randomized DEDICATION (Drug Elution and Distal Protection in Acute Myocardial Infarction) trial evaluated the outcome after DES compared with BMS implantation in patients with STEMI undergoing primary percutaneous coronary intervention.

METHODS

Patients with a high-grade stenosis/occlusion of a native coronary artery presenting with symptoms <12 h and ST-segment elevation were enrolled after giving informed consent. Patients were randomly assigned to receive a DES or a BMS in the infarct-related lesion. Patients were followed for at least 5 years, and clinical endpoints were evaluated from population registries and hospital charts. The main endpoint was the occurrence of the first major adverse cardiac event (MACE), defined as cardiac death, nonfatal recurrent myocardial infarction, and target lesion revascularization.

RESULTS

Complete clinical status was available in 623 patients (99.5%) at 5 years follow-up. The combined MACE rate was insignificantly lower in the DES group (16.9% vs. 23%), mainly driven by a lower need of repeat revascularization (p = 0.07). Whereas the number of deaths from all causes tended to be higher in the DES group (16.3% vs. 12.1%, p = 0.17), cardiac mortality was significantly higher (7.7% vs. 3.2%, p = 0.02). The 5-year stent thrombosis rates were generally low and similar between the DES and the BMS groups. No cardiac deaths occurring within 1 month could be clearly ascribed to stent thrombosis, whereas stent thrombosis was involved in 78% of later-occurring deaths.

CONCLUSIONS

The 5-year MACE rate was insignificantly different, but the cardiac mortality was higher after DES versus BMS implantation in patients with STEMI. Stent thrombosis was the main cause of late cardiac deaths.

Authors+Show Affiliations

Department of Cardiology and Cardiac Catheterization Laboratory, Rigshospitalet, University of Copenhagen, Denmark.No 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 availableNo 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
Randomized Controlled Trial

Language

eng

PubMed ID

23683734

Citation

Holmvang, Lene, et al. "Long-term Outcome After Drug-eluting Versus Bare-metal Stent Implantation in Patients With ST-segment Elevation Myocardial Infarction: 5 Years Follow-up From the Randomized DEDICATION Trial (Drug Elution and Distal Protection in Acute Myocardial Infarction)." JACC. Cardiovascular Interventions, vol. 6, no. 6, 2013, pp. 548-53.
Holmvang L, Kelbæk H, Kaltoft A, et al. Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: 5 years follow-up from the randomized DEDICATION trial (Drug Elution and Distal Protection in Acute Myocardial Infarction). JACC Cardiovasc Interv. 2013;6(6):548-53.
Holmvang, L., Kelbæk, H., Kaltoft, A., Thuesen, L., Lassen, J. F., Clemmensen, P., Kløvgaard, L., Engstrøm, T., Bøtker, H. E., Saunamäki, K., Krusell, L. R., Jørgensen, E., Tilsted, H. H., Christiansen, E. H., Ravkilde, J., Køber, L., Kofoed, K. F., Terkelsen, C. J., & Helqvist, S. (2013). Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: 5 years follow-up from the randomized DEDICATION trial (Drug Elution and Distal Protection in Acute Myocardial Infarction). JACC. Cardiovascular Interventions, 6(6), 548-53. https://doi.org/10.1016/j.jcin.2012.12.129
Holmvang L, et al. Long-term Outcome After Drug-eluting Versus Bare-metal Stent Implantation in Patients With ST-segment Elevation Myocardial Infarction: 5 Years Follow-up From the Randomized DEDICATION Trial (Drug Elution and Distal Protection in Acute Myocardial Infarction). JACC Cardiovasc Interv. 2013;6(6):548-53. PubMed PMID: 23683734.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: 5 years follow-up from the randomized DEDICATION trial (Drug Elution and Distal Protection in Acute Myocardial Infarction). AU - Holmvang,Lene, AU - Kelbæk,Henning, AU - Kaltoft,Anne, AU - Thuesen,Leif, AU - Lassen,Jens Flensted, AU - Clemmensen,Peter, AU - Kløvgaard,Lene, AU - Engstrøm,Thomas, AU - Bøtker,Hans E, AU - Saunamäki,Kari, AU - Krusell,Lars R, AU - Jørgensen,Erik, AU - Tilsted,Hans-Henrik, AU - Christiansen,Evald H, AU - Ravkilde,Jan, AU - Køber,Lars, AU - Kofoed,Klaus Fuglsang, AU - Terkelsen,Christian J, AU - Helqvist,Steffen, Y1 - 2013/05/15/ PY - 2012/11/09/received PY - 2012/11/11/revised PY - 2012/12/21/accepted PY - 2013/5/21/entrez PY - 2013/5/21/pubmed PY - 2014/2/5/medline SP - 548 EP - 53 JF - JACC. Cardiovascular interventions JO - JACC Cardiovasc Interv VL - 6 IS - 6 N2 - OBJECTIVES: This study sought to compare the long-term effects of drug-eluting stent (DES) compared with bare-metal stent (BMS) implantation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. BACKGROUND: The randomized DEDICATION (Drug Elution and Distal Protection in Acute Myocardial Infarction) trial evaluated the outcome after DES compared with BMS implantation in patients with STEMI undergoing primary percutaneous coronary intervention. METHODS: Patients with a high-grade stenosis/occlusion of a native coronary artery presenting with symptoms <12 h and ST-segment elevation were enrolled after giving informed consent. Patients were randomly assigned to receive a DES or a BMS in the infarct-related lesion. Patients were followed for at least 5 years, and clinical endpoints were evaluated from population registries and hospital charts. The main endpoint was the occurrence of the first major adverse cardiac event (MACE), defined as cardiac death, nonfatal recurrent myocardial infarction, and target lesion revascularization. RESULTS: Complete clinical status was available in 623 patients (99.5%) at 5 years follow-up. The combined MACE rate was insignificantly lower in the DES group (16.9% vs. 23%), mainly driven by a lower need of repeat revascularization (p = 0.07). Whereas the number of deaths from all causes tended to be higher in the DES group (16.3% vs. 12.1%, p = 0.17), cardiac mortality was significantly higher (7.7% vs. 3.2%, p = 0.02). The 5-year stent thrombosis rates were generally low and similar between the DES and the BMS groups. No cardiac deaths occurring within 1 month could be clearly ascribed to stent thrombosis, whereas stent thrombosis was involved in 78% of later-occurring deaths. CONCLUSIONS: The 5-year MACE rate was insignificantly different, but the cardiac mortality was higher after DES versus BMS implantation in patients with STEMI. Stent thrombosis was the main cause of late cardiac deaths. SN - 1876-7605 UR - https://www.unboundmedicine.com/medline/citation/23683734/Long_term_outcome_after_drug_eluting_versus_bare_metal_stent_implantation_in_patients_with_ST_segment_elevation_myocardial_infarction:_5_years_follow_up_from_the_randomized_DEDICATION_trial__Drug_Elution_and_Distal_Protection_in_Acute_Myocardial_Infarction__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-8798(13)00629-8 DB - PRIME DP - Unbound Medicine ER -