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Int J Cardiol. 2017 Dec 1;248:120-123. doi: 10.1016/j.ijcard.2017.06.070. Epub 2017 Aug 30.

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

Author information

1
London Health Sciences Centre, Western University, London, ON, Canada. Electronic address: Shahar.lavi@lhsc.on.ca.
2
South Yorkshire Cardiothoracic Centre, Sheffield, UK. Electronic address: J.Iqbal@sheffield.ac.uk.
3
Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Electronic address: John.Cairns@ubc.ca.
4
Southlake Regional Health Centre, Newmarket, University of Toronto, ON, Canada. Electronic address: Cantorw@rogers.com.
5
St. Michael's Hospital, Toronto, ON, Canada. Electronic address: Cheemaa@smh.ca.
6
University Hospital La Paz, Madrid, Spain.
7
The Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada. Electronic address: Brandi.Meeks@phri.ca.
8
Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. Electronic address: Robert.Welsh@albertahealthservices.ca.
9
University Clinic of Cardiology, Medical Faculty, University of St. Cyril & Methodius, Skopje, Macedonia.
10
University Hospital of South Manchester, Manchester, United Kingdom. Electronic address: Saqib.Chowdhary@uhsm.nhs.uk.
11
Clinical Center of Serbia, Department of Cardiology, Medical Faculty, University of Belgrade, Belgrade, Serbia.
12
The Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada. Electronic address: schwalj@mcmaster.ca.
13
The Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada. Electronic address: yanyun.liu@phri.ca.
14
The Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada. Electronic address: Sanjit.Jolly@phri.ca.
15
Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada. Electronic address: Vlad.Dzavik@uhn.ca.

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.

KEYWORDS:

Bare metal stent; Drug-eluting stent; STEMI

PMID:
28865897
DOI:
10.1016/j.ijcard.2017.06.070
[Indexed for MEDLINE]

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