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N Engl J Med. 2009 May 7;360(19):1946-59. doi: 10.1056/NEJMoa0810116.

Paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction.

Collaborators (175)

Stone GW, Brodie BR, Cox DA, Grines CL, Rutherford BD, Bhatt D, Dangas G, Feit F, Ohman M, Bonnier H, Colombo A, Garcia E, Grube E, Guagliumi G, Kastrati A, Serruys P, Suryapranata H, Bonnier H, Suryapranata H, Colombo A, Guagliumi G, Garcia E, Grube E, Kastrati A, Almagor Y, Banning A, Belardi J, Grinfeld L, Dudek D, Huber K, Nilsen D, Olivecrona G, Rasmussen L, Wong SC, Farkouh M, Attubato M, Dangas G, Feit F, Mehran R, Winsted D, Mehran R, Gambone L, Bihl I, Parise H, Gersh BJ, Faxon D, King S, Pocock SJ, Williams DO, Lansky AJ, Cristea E, Reiffel J, Mintz G, Mendiz OA, Amadeo Alvarez J, Alvarez J, Grinfeld DD, Riccitelli MA, Berrocal D, Belardi J, Damonte AA, Cugat G, Rodriguez A, Torresani EM, Londero HF, Glogar D, Huber K, Gaul G, Altenberger J, Pachinger O, Olbrich HG, Witzenbichler B, Moeckel M, Rutsch W, Grube E, Richardt G, Pethig K, Desaga M, Werner G, Brachmann J, Kuecherer H, Hoffmann R, Hartmann F, Willems S, Wöhrle J, Kastrati A, Krakover R, Rosenschein U, Lewis BS, Mosseri M, Kornowski RP, Gruberg L, Almagor Y, Guetta V, Finkelstein A, Rozenman Y, Guagliumi G, Colombo A, Bonnier H, Suryapranata H, Smits P, Nordrehaug JE, Nilsen D, Ruzyllo W, Witkowski A, Dudek D, Rynkiewicz A, Peruga JZ, Ochala A, Zmudka K, Gil R, Bordes P, Banning A, Blackman D, El-Omar M, De Belder A, Grech E, Prendergast B, Johnson S, McLaurin B, Lee T, Pinto DS, Choo J, Karlsberg R, Cannon LA, Sharma T, Ritter J, Rabbani L, Leimgruber PP, Quintana O, McGarvey J Jr, Aguilar O, Liberman H, Blankenship J, Razavi A, Dave R, Rashid J, Stella JF, Finkinski E, Bach M, Brodie B, Kellett MA Jr, Quintana O, Waksman R, Iwaoka R, Eaton GM, Atassi K, Attubato M, Chandwaney R, Evans B, Aguilar O, Lui H, Rizik D, Rizik D, Griffin J, Hall JO, Foster MC, Hernandez JA, Camba N, LaLonde T, Bikkina M, Rutherford B, Singh V, McPherson J, Zelman RB, Hermiller JB, Korr KS, Metzger C, Gordon P, Hirsch C, Srinivasan V, Habet K, Turco MA, Ebersole D, Grines CL.

Author information

  • 1Columbia University Medical Center and New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY 10022, USA. gs2184@columbia.edu

Abstract

BACKGROUND:

There is no consensus regarding the safety and efficacy of drug-eluting stents, as compared with bare-metal stents, in patients with ST-segment elevation myocardial infarction who are undergoing primary percutaneous coronary intervention (PCI).

METHODS:

We randomly assigned, in a 3:1 ratio, 3006 patients presenting with ST-segment elevation myocardial infarction to receive paclitaxel-eluting stents (2257 patients) or otherwise identical bare-metal stents (749 patients). The two primary end points of the study were the 12-month rates of target-lesion revascularization for ischemia (analysis powered for superiority) and a composite safety outcome measure of death, reinfarction, stroke, or stent thrombosis (powered for noninferiority with a 3.0% margin). The major secondary end point was angiographic evidence of restenosis at 13 months.

RESULTS:

Patients who received paclitaxel-eluting stents, as compared with those who received bare-metal stents, had significantly lower 12-month rates of ischemia-driven target-lesion revascularization (4.5% vs. 7.5%; hazard ratio, 0.59; 95% confidence interval [CI], 0.43 to 0.83; P=0.002) and target-vessel revascularization (5.8% vs. 8.7%; hazard ratio, 0.65; 95% CI, 0.48 to 0.89; P=0.006), with noninferior rates of the composite safety end point (8.1% vs. 8.0%; hazard ratio, 1.02; 95% CI, 0.76 to 1.36; absolute difference, 0.1 percentage point; 95% CI, -2.1 to 2.4; P=0.01 for noninferiority; P=0.92 for superiority). Patients treated with paclitaxel-eluting stents and those treated with bare-metal stents had similar 12-month rates of death (3.5% and 3.5%, respectively; P=0.98) and stent thrombosis (3.2% and 3.4%, respectively; P=0.77). The 13-month rate of binary restenosis was significantly lower with paclitaxel-eluting stents than with bare-metal stents (10.0% vs. 22.9%; hazard ratio, 0.44; 95% CI, 0.33 to 0.57; P<0.001).

CONCLUSIONS:

In patients with ST-segment elevation myocardial infarction who were undergoing primary PCI, implantation of paclitaxel-eluting stents, as compared with bare-metal stents, significantly reduced angiographic evidence of restenosis and recurrent ischemia necessitating repeat revascularization procedures. No safety concerns were apparent at 1 year. (ClinicalTrials.gov number, NCT00433966.)

2009 Massachusetts Medical Society

PMID:
19420364
[PubMed - indexed for MEDLINE]
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