Original article
Outcomes of drug-eluting stents compared to bare-metal stents in ST-segment elevation acute myocardial infarction
Comparação entre stents revestidos e não revestidos por fármaco no enfarte agudo do miocárdio com supradesnivelamento de ST
João Brito
, Manuel Almeida, Rui Campante Teles, Pedro Sousa, João Abecasis, Rita Calé, Pedro Gonçalves, Luís Raposo, Miguel Mendes
Corresponding author
Serviço de Cardiogia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
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] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "João Brito, Manuel Almeida, Rui Campante Teles, Pedro Sousa, João Abecasis, Rita Calé, Pedro Gonçalves, Luís Raposo, Miguel Mendes" "autores" => array:9 [ 0 => array:4 [ "nombre" => "João" "apellidos" => "Brito" "email" => array:1 [ 0 => "jdbrito@netcabo.pt" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Manuel" "apellidos" => "Almeida" ] 2 => array:2 [ "nombre" => "Rui" "apellidos" => "Campante Teles" ] 3 => array:2 [ "nombre" => "Pedro" "apellidos" => "Sousa" ] 4 => array:2 [ "nombre" => "João" "apellidos" => "Abecasis" ] 5 => array:2 [ "nombre" => "Rita" "apellidos" => "Calé" ] 6 => array:2 [ "nombre" => "Pedro" "apellidos" => "Gonçalves" ] 7 => array:2 [ "nombre" => "Luís" "apellidos" => "Raposo" ] 8 => array:2 [ "nombre" => "Miguel" "apellidos" => "Mendes" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Serviço de Cardiogia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Comparação entre <span class="elsevierStyleItalic">stents</span> revestidos e não revestidos por fármaco no enfarte agudo do miocárdio com supradesnivelamento de ST" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-03-18" "fechaAceptado" => "2011-06-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec164349" "palabras" => array:4 [ 0 => "Stents" 1 => "Myocardial infarction" 2 => "Percutaneous coronary intervention" 3 => "Coronary disease/therapy" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec164350" "palabras" => array:4 [ 0 => "<span class="elsevierStyleItalic">Stents</span>" 1 => "Enfarte do miocárdio" 2 => "Intervenção coronária percutânea" 3 => "Doença coronária/terapêutica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Primary percutaneous coronary intervention (PPCI) has become the treatment of choice in patients with ST-segment elevation myocardial infarction (STEMI). Drug-eluting stents (DES) reduce restenosis compared to bare-metal stents (BMS) but there is conflicting data concerning their use in the setting of STEMI. We aimed to evaluate the influence of the type of stent on the outcomes of PPCI.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a single-center longitudinal study including 213 consecutive patients (76% men, mean age 60±12 years) with STEMI undergoing PPCI between 2003 and 2007, divided into two groups: BMS (43.7%) and DES (56.3%). We assessed clinical and demographic features as well as angiographic and electrocardiographic signs of myocardial reperfusion. The composite outcome of death, myocardial infarction (MI) or target-lesion revascularization (TLR) was evaluated.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">At a median follow-up of 26 months there were no differences in the composite outcome of death/MI/TLR (BMS 18.3% vs DES 15.8%) or in the incidence of stent thrombosis. Angiographic results of the procedure were also similar. Independent predictors of the composite outcome were age (HR=1.06, 95% CI [1.02-1.11], left anterior descending artery as infarct-related vessel (HR=2.69, 95% CI [1.17-6.19]) and use of glycoprotein IIb/IIIa inhibitors (HR=0.33, 95% CI [0.13-0.83]).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">There was no benefit in angiographic outcomes or major cardiac events after treatment with drug-eluting stents compared to bare-metal stents in this group of patients with STEMI.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span class="elsevierStyleSectionTitle">Introdução</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A angioplastia primária (ICPP) é o tratamento de eleição para enfarte agudo do miocárdio com elevação de ST (EAM ST). Os <span class="elsevierStyleItalic">stents</span> farmacológicos (DES) permitem reduzir a taxa de restenose coronária, sendo controverso o seu uso no contexto de EAM ST. O objectivo deste estudo foi avaliar os resultados clínicos da ICPP em função do tipo de <span class="elsevierStyleItalic">stent</span> usado (não revestido <span class="elsevierStyleItalic">versus</span> DES).</p> <span class="elsevierStyleSectionTitle">População e métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo longitudinal de centro único, incluindo 213 doentes consecutivos, idade média 60<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12 anos, 76% homens, submetidos a ICPP no contexto de EAM ST, entre 2003 e Novembro 2007. Foram considerados 2 grupos: <span class="elsevierStyleItalic">stent</span> não revestidos (BMS) (43,7%) e DES (56,3%). Analisaram-se as características clínicas e demográficas dos 2 grupos, comparando-se também variáveis angiográficas, de perfusão miocárdica, grau de resolução de segmento ST pós-ICPP e pico de troponina. Determinou-se no seguimento a incidência do evento combinado: morte, enfarte do miocárdio (EAM) ou revascularização de lesão alvo (TLR).</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">No seguimento mediano de 26 meses não se encontraram diferenças no evento combinado Morte/EAM/TLR (BMS 18,3% <span class="elsevierStyleItalic">versus</span> 15,8%) nem na trombose de <span class="elsevierStyleItalic">stent</span>. Os resultados angiográficos foram também semelhantes. Os preditores independentes de morte/EAM/TLR foram a frequência cardíaca (HR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.06 95% IC [1.02-1.11], descendente anterior como vaso <span class="elsevierStyleItalic">culprit</span> (HR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2.69 95% IC [1.17-6.19]) e utilização de inibidores da glicoproteína IIbIIIa (HR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.33 95% IC [0.13-0.83]).</p> <span class="elsevierStyleSectionTitle">Conclusão</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">O tipo de <span class="elsevierStyleItalic">stent</span> utilizado não parece ter influência na ocorrência de eventos cardíacos em doentes submetidos a angioplastia primária, no contexto de EAM ST.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of coronary stenting versus conventional balloon angioplasty on five-year mortality in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.H. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 35 | 36 | 71 |
| 2024 September | 33 | 30 | 63 |
| 2024 August | 42 | 54 | 96 |
| 2024 July | 30 | 27 | 57 |
| 2024 June | 16 | 27 | 43 |
| 2024 May | 23 | 19 | 42 |
| 2024 April | 21 | 39 | 60 |
| 2024 March | 23 | 21 | 44 |
| 2024 February | 20 | 22 | 42 |
| 2024 January | 22 | 31 | 53 |
| 2023 December | 32 | 29 | 61 |
| 2023 November | 21 | 26 | 47 |
| 2023 October | 17 | 15 | 32 |
| 2023 September | 16 | 25 | 41 |
| 2023 August | 21 | 25 | 46 |
| 2023 July | 27 | 24 | 51 |
| 2023 June | 12 | 18 | 30 |
| 2023 May | 25 | 27 | 52 |
| 2023 April | 15 | 2 | 17 |
| 2023 March | 16 | 29 | 45 |
| 2023 February | 20 | 21 | 41 |
| 2023 January | 10 | 11 | 21 |
| 2022 December | 14 | 19 | 33 |
| 2022 November | 29 | 28 | 57 |
| 2022 October | 17 | 22 | 39 |
| 2022 September | 17 | 31 | 48 |
| 2022 August | 22 | 32 | 54 |
| 2022 July | 19 | 30 | 49 |
| 2022 June | 16 | 22 | 38 |
| 2022 May | 15 | 26 | 41 |
| 2022 April | 19 | 26 | 45 |
| 2022 March | 17 | 35 | 52 |
| 2022 February | 18 | 20 | 38 |
| 2022 January | 11 | 22 | 33 |
| 2021 December | 16 | 35 | 51 |
| 2021 November | 26 | 35 | 61 |
| 2021 October | 22 | 40 | 62 |
| 2021 September | 29 | 30 | 59 |
| 2021 August | 18 | 34 | 52 |
| 2021 July | 16 | 25 | 41 |
| 2021 June | 21 | 19 | 40 |
| 2021 May | 21 | 33 | 54 |
| 2021 April | 48 | 18 | 66 |
| 2021 March | 37 | 27 | 64 |
| 2021 February | 49 | 22 | 71 |
| 2021 January | 22 | 20 | 42 |
| 2020 December | 13 | 10 | 23 |
| 2020 November | 28 | 13 | 41 |
| 2020 October | 15 | 8 | 23 |
| 2020 September | 46 | 9 | 55 |
| 2020 August | 16 | 7 | 23 |
| 2020 July | 41 | 11 | 52 |
| 2020 June | 32 | 13 | 45 |
| 2020 May | 31 | 5 | 36 |
| 2020 April | 21 | 12 | 33 |
| 2020 March | 38 | 10 | 48 |
| 2020 February | 40 | 19 | 59 |
| 2020 January | 30 | 11 | 41 |
| 2019 December | 28 | 7 | 35 |
| 2019 November | 31 | 5 | 36 |
| 2019 October | 24 | 15 | 39 |
| 2019 September | 31 | 11 | 42 |
| 2019 August | 21 | 9 | 30 |
| 2019 July | 27 | 8 | 35 |
| 2019 June | 14 | 8 | 22 |
| 2019 May | 35 | 26 | 61 |
| 2019 April | 14 | 24 | 38 |
| 2019 March | 39 | 19 | 58 |
| 2019 February | 66 | 13 | 79 |
| 2019 January | 35 | 2 | 37 |
| 2018 December | 36 | 14 | 50 |
| 2018 November | 63 | 8 | 71 |
| 2018 October | 75 | 18 | 93 |
| 2018 September | 28 | 12 | 40 |
| 2018 August | 28 | 9 | 37 |
| 2018 July | 13 | 3 | 16 |
| 2018 June | 33 | 6 | 39 |
| 2018 May | 43 | 5 | 48 |
| 2018 April | 32 | 11 | 43 |
| 2018 March | 45 | 6 | 51 |
| 2018 February | 37 | 9 | 46 |
| 2018 January | 22 | 5 | 27 |
| 2017 December | 51 | 4 | 55 |
| 2017 November | 42 | 7 | 49 |
| 2017 October | 38 | 7 | 45 |
| 2017 September | 27 | 8 | 35 |
| 2017 August | 21 | 17 | 38 |
| 2017 July | 16 | 7 | 23 |
| 2017 June | 31 | 9 | 40 |
| 2017 May | 30 | 6 | 36 |
| 2017 April | 28 | 5 | 33 |
| 2017 March | 22 | 14 | 36 |
| 2017 February | 28 | 4 | 32 |
| 2017 January | 20 | 2 | 22 |
| 2016 December | 34 | 8 | 42 |
| 2016 November | 20 | 5 | 25 |
| 2016 October | 24 | 8 | 32 |
| 2016 September | 13 | 6 | 19 |
| 2016 August | 4 | 1 | 5 |
| 2016 July | 12 | 7 | 19 |
| 2016 June | 4 | 4 | 8 |
| 2016 May | 6 | 6 | 12 |
| 2016 April | 11 | 1 | 12 |
| 2016 March | 18 | 12 | 30 |
| 2016 February | 24 | 17 | 41 |
| 2016 January | 28 | 11 | 39 |
| 2015 December | 16 | 13 | 29 |
| 2015 November | 19 | 12 | 31 |
| 2015 October | 29 | 12 | 41 |
| 2015 September | 21 | 13 | 34 |
| 2015 August | 23 | 8 | 31 |
| 2015 July | 15 | 5 | 20 |
| 2015 June | 15 | 4 | 19 |
| 2015 May | 21 | 4 | 25 |
| 2015 April | 21 | 6 | 27 |
| 2015 March | 16 | 2 | 18 |
| 2015 February | 11 | 3 | 14 |
| 2015 January | 11 | 5 | 16 |
| 2014 December | 20 | 9 | 29 |
| 2014 November | 17 | 8 | 25 |
| 2014 October | 14 | 3 | 17 |
| 2014 September | 23 | 8 | 31 |
| 2014 August | 16 | 8 | 24 |
| 2014 July | 22 | 7 | 29 |
| 2014 June | 23 | 3 | 26 |
| 2014 May | 29 | 5 | 34 |
| 2014 April | 18 | 2 | 20 |
| 2014 March | 28 | 10 | 38 |
| 2014 February | 23 | 8 | 31 |
| 2014 January | 30 | 10 | 40 |
| 2013 December | 32 | 8 | 40 |
| 2013 November | 29 | 13 | 42 |
| 2013 October | 25 | 9 | 34 |
| 2013 September | 36 | 14 | 50 |
| 2013 August | 33 | 19 | 52 |
| 2013 July | 33 | 18 | 51 |
| 2013 June | 23 | 3 | 26 |
| 2013 May | 26 | 9 | 35 |
| 2013 April | 46 | 19 | 65 |
| 2013 March | 28 | 9 | 37 |
| 2013 February | 32 | 15 | 47 |
| 2013 January | 32 | 12 | 44 |
| 2012 December | 15 | 12 | 27 |
| 2012 November | 24 | 8 | 32 |
| 2012 October | 5 | 2 | 7 |
| 2012 September | 10 | 4 | 14 |
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