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.

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.

• Authors: Hui-Liang Liu, Zhi-Geng Jin, Sheng-Li Yang, Wei Han, Quan-Min Jing, Lei Zhang, Jian-Ping Luo, Dong-Xing Ma, Ying Liu, Li-Xia Yang, Tie-Min Jiang, Peng Qu, Wei-Min Li, Shu-Mei Li, Bo Xu, Run-Lin Gao, Ya-Ling Han
• Journal: Journal of cardiology (J Cardiol) Vol. 69 Issue 1 Pg. 149-155 (01 2017) ISSN: 1876-4738 [Electronic] Netherlands
• PMID: 26972344 (Publication Type: Clinical Trial, Journal Article)
• Copyright: Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Polymers
• Sirolimus

Topics

• Absorbable Implants (statistics & numerical data)
• Acute Coronary Syndrome (drug therapy, surgery)
• Aged
• Anti-Bacterial Agents (administration & dosage)
• Drug-Eluting Stents (statistics & numerical data)
• Female
• Humans
• Male
• Middle Aged
• Polymers
• ST Elevation Myocardial Infarction (drug therapy, surgery)
• Sirolimus (administration & dosage)
• Time Factors
• Treatment Outcome