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Long-term outcomes of intravascular ultrasound-guided implantation of bare metal stents versus drug-eluting stents in primary percutaneous coronary intervention

Korean Journal of Internal Medicine 2014년 29권 1호 p.66 ~ p.75

조윤경(Cho Yun-Kyeong) - Keimyung University School of Medicine Department of Internal Medicine
허승호(Hur Seung-Ho) - Keimyung University School of Medicine Department of Internal Medicine
박남희(Park Nam-Hee) - Keimyung University School of Medicine Department of Cardiothoracic Surgery
최상웅(Choi Sang-Woong) - Keimyung University School of Medicine Department of Internal Medicine
(Sohn Ji-Hyun) - Keimyung University School of Medicine Department of Internal Medicine
조현옥(Cho Hyun-Ok) - Keimyung University School of Medicine Department of Internal Medicine
박형섭(Park Hyoung-Seob) - Keimyung University School of Medicine Department of Internal Medicine
윤혁준(Yoon Hyuck-Jun) - Keimyung University School of Medicine Department of Internal Medicine
김형섭(Kim Hyung-Seop) - Keimyung University School of Medicine Department of Internal Medicine
남창욱(Nam Chang-Wook) - Keimyung University School of Medicine Department of Internal Medicine
김윤년(Kim Yoon-Nyun) - Keimyung University School of Medicine Department of Internal Medicine
김권배(Kim Kwon-Bae) - Keimyung University School of Medicine Department of Internal Medicine

Abstract

Background/Aims: While drug-eluting stents (DESs) have shown favorable outcomes in ST-segment elevation myocardial infarction (STEMI) compared to bare metal stents (BMSs), there are concerns about the risk of stent thrombosis (ST) with DESs. Because intravascular ultrasound (IVUS) guidance may help optimize stent placement and improve outcomes in percutaneous coronary intervention (PCI) patients, we evaluated the impact of IVUS-guided BMS versus DES implantation on long-term outcomes in primary PCI.

Methods: In all, 239 STEMI patients received DES (n = 172) or BMS (n = 67) under IVUS guidance in primary PCI. The 3-year incidence of major adverse cardiac events (MACEs) including death, myocardial infarction (MI), target vessel revascularization (TVR), and ST was evaluated.

Results: There was no difference in all cause mortality or MI. However, the incidence of TVR was 23.9% with BMS versus 9.3% with DES (p = 0.005). Thus, the number of MACEs was significantly lower with DES (11.0% vs. 29.9%; p = 0.001). The incidence of definite or probable ST was not different (1.5% vs. 2.3%; p = 1.0). IVUS-guided DES implantation (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.08 to 0.78; p = 0.017), stent length (HR, 1.03; 95% CI, 1.00 to 1.06; p = 0.046), and multivessel disease (HR, 3.01; 95% CI, 1.11 to 8.15; p = 0.030) were independent predictors of MACE.

Conclusions: In patients treated with primary PCI under IVUS guidance, the use of DES reduced the incidence of 3-year TVR versus BMS. However, all cause mortality and MI were similar between the groups. The incidence of ST was low in both groups.