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J Cardiol. 2017 Jan;69(1):149-155. doi: 10.1016/j.jjcc.2016.02.012. Epub 2016 Mar 10.

Five-year outcomes of ST-elevation myocardial infarction versus non-ST-elevation acute coronary syndrome treated with biodegradable polymer-coated sirolimus-eluting stents: Insights from the CREATE trial.

Author information

1
General Hospital of Chinese People's Armed Police Forces, Beijing, China.
2
Shenyang Northern Hospital, Shenyang, Liaoning, China.
3
Kunming General Hospital of Chengdu Military Region, Kunming, China.
4
Affiliated Hospital of Chinese People's Armed Police Forces Medical College, Tianjin, China.
5
The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
6
The First Clinical Medical College of Harbin Medical University, Harbin, China.
7
The Second Hospital of Jilin University, Changchun, China.
8
FuWai Hospital, Beijing, China.
9
Shenyang Northern Hospital, Shenyang, Liaoning, China. Electronic address: yalinghan_nh@126.com.

Abstract

BACKGROUND:

Long-term outcome of drug-eluting stents (DES) for ST-elevation myocardial infarction (STEMI) versus non-ST-elevation acute coronary syndrome (NSTE-ACS) remains unclear. This study sought to compare the long-term outcomes of biodegradable polymer-coated DES in patients with STEMI versus NSTE-ACS.

METHODS:

We explored a post hoc analysis of the 5-year outcome of the CREATE trial in the subgroup of patients with STEMI (n=318) versus NSTE-ACS (n=1223) who were implanted with biodegradable polymer-coated DES. The primary outcome was the rate of major adverse cardiac events (MACE) at 5 years. Clopidogrel and aspirin for 6 months followed by chronic aspirin therapy were recommended.

RESULTS:

STEMI patients showed a trend of increase in MACE (8.7% vs. 6.8%, log rank p=0.289) compared to NSTE-ACS patients at 5 years, and a greater risk of cardiac death (5.4% vs. 2.1%, log rank p=0.003), mainly driven by the higher cardiac death rate within the first month after stent placement (log rank p=0.003) and the last year of follow-up (log rank p=0.001). No significant difference in stent thrombosis was found between them (3.1% vs. 2.5%, log rank p=0.653). Prolonged clopidogrel therapy (>6 months) showed no effect on risk of MACE or stent thrombosis between the two groups (both p for interaction >0.1).

CONCLUSIONS:

STEMI patients have a higher risk of cardiac mortality compared with NSTE-ACS patients after biodegradable polymer-coated DES placement, primarily attribute to more cardiac deaths that happened within the first month after the event and the last year of follow-up.

KEYWORDS:

Acute coronary syndrome; Biodegradable polymer; Drug eluting stent; Myocardial infarction

PMID:
26972344
DOI:
10.1016/j.jjcc.2016.02.012
[Indexed for MEDLINE]
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