Bare metal versus drug eluting stents for ST-segment elevation myocardial infarction in the TOTAL trial

Shahar Lavi, Javaid Iqbal, John A. Cairns, Warren J. Cantor, Asim N. Cheema, Raul Moreno, Brandi Meeks, Robert C. Welsh, Sasko Kedev, Saqib Chowdhary, Goran Stankovic, J. D. Schwalm, Yan Liu, Sanjit S. Jolly, Vladimír Džavík

Research output: Contribution to journalArticlepeer-review

Abstract

Background The safety and efficacy of drug eluting stents (DES) in the setting of ST elevation myocardial infarction (STEMI) is not well established. Methods In the TOTAL trial, patients presenting with STEMI were randomized to routine thrombectomy versus PCI alone. In this post-hoc analysis, propensity matching was used to assess relative safety and efficacy according to type of stent used. Results Each propensity-matched cohort included 2313 patients. The composite primary outcome of cardiovascular death, recurrent MI, cardiogenic shock or class IV heart failure within one year was lower in the DES group (HR 0.67; 95% CI 0.54 to 0.84, p = 0.0004). Cardiovascular death (HR 0.61; 95% CI 0.43 to 0.86, p = 0.005), recurrent MI (HR 0.51; 95% CI 0.35 to 0.75, p = 0.0005), target vessel revascularization (HR 0.47; 95% CI 0.36 to 0.62, p < 0.0001) and stent thrombosis (HR 0.60; 95% CI 0.40 to 0.89, p = 0.01) were lower in the DES group. There was no difference in major bleeding between groups. Conclusions In this observational analysis, the use of DES was associated with improvement in cardiovascular outcomes compared to the use of BMS. These results support the use of DES during primary PCI for STEMI.

Original languageEnglish
Pages (from-to)120-123
Number of pages4
JournalInternational Journal of Cardiology
Volume248
Early online date30 Aug 2017
DOIs
Publication statusPublished - 2017

Keywords

  • Bare metal stent
  • Drug-eluting stent
  • STEMI

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