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ȣ - 520054 7 |
| Drug-Eluting Stents Are Not Superior to Bare-Metal Stents in Elderly Patients with Acute Myocardial Infarction |
| 대한심장학회 Korea Acute Myocardial Infarction Registry 연구자 |
| 심두선, 정명호, 안영근, 채성철, 허승호, 성인환, 김종현, 홍택종, 구본권, 채제건, 채동훈, 윤정한, 배장호, 나승운, 류제영, 김두일, 김기식, 김병옥, 오석규, 채인호, 이명용, 정경태, 조명찬, 김종진, 김영조, 외 Korea Acute Myocardial Infarction Registry Investigators |
Background: Recent randomized controlled clinical trials comparing drug-eluting stents (DES) and bare-metal stents (BMS) for treatment of coronary artery disease have indicated that although the use of DES reduces rates of coronary restenosis after percutaneous coronary intervention (PCI), it does not reduce the rates of mortality or acute myocardial infarction (AMI). We sought to determine whether DES were associated with improved clinical outcomes compared with BMS among elderly patients (≥ 75 years of age) with AMI.
Methods: We evaluated 1,034 patients with DES (80±4 years, 500 males) and 100 patients treated with BMS (80±4 years of age, 48 males) between Nov 2005 and Jan 2007, using data series from the Korea Acute Myocardial Infarction Registry. The outcome analysis covering a period of up to 12 months was conducted. In a subgroup analysis, we separately evaluated the cohort of patients who had undergone stenting only in one vessel (the single-vessel subgroup) at the initial PCI: 447 patients with DES (80±4 years, 234 males) and 55 patients with BMS (80±4 years, 31 males).
Results: In the group with DES, more patients had multi-vessel (56.3 vs. 43.0%, p=0.011) and LAD (49.4 vs. 35.0%, p = 0.006), had longer (25.9±6.8 vs. 22.5±5.7 mm, p<0.0005) and smaller (3.1±0.3 vs. 3.4±0.7 mm, p<0.0005) stents, and had a higher number of implanted stents (1.3±0.5 vs. 1.1±0.4, p=0.009). In the single-vessel PCI subgroup, the DES were generally longer (25.9±6.8 vs. 22.5±5.8 mm, p<0.0005) and smaller diameters (3.1±0.3 vs. 3.4±0.7 mm, p<0.0005) than the BMS. However, the two groups did not differ in the composite of death, MI, and repeat revascularization during the 12 months of follow-up (DES vs. BMS: 4.3 vs. 2.0%, p=0.275). Subgroup analysis of patients who underwent single-vessel PCI also failed to yield any significant difference in the MACE between the two groups (DES vs. BMS: 2.7 vs. 3.6%, p=0.658).
Conclusions: DES in elderly patients with AMI were not associated with improved outcomes, as compared with BMS, during a 12-month clinical follow-up.
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