Everolimus-eluting stent versus bare metal stent in proximal left anterior descending ST-elevation myocardial infarction : Insights from the EXAMINATION trial - 29/06/13
, Salvatore Brugaletta, MD PhD c, Joan-Antoni Gomez-Hospital, MD PhD a, b, Jose Luis Ferreiro, MD a, b, Gerard Roura, MD a, b, Rafael Romaguera, MD a, b, Victoria Martin-Yuste, MD c, Monica Masotti, MD, PhD c, Andrés Iñiguez, MD, PhD d, Antonio Serra, MD, PhD e, Rosana Hernandez-Antolin, MD, PhD f, Vicente Mainar, MD, PhD g, Marco Valgimigli, MD, PhD h, Maurizio Tespili, MD, PhD i, Pieter den Heijer, MD, PhD j, Armando Bethencourt, MD, PhD k, Nicolás Vazquez, MD, PhD l, Patrick Serruys, MD, PhD m, Manel Sabate, MD, PhD c, Angel Cequier, MD, PhD a, bRésumé |
Background |
ST-elevation myocardial infarctions (STEMI) caused by proximal left-anterior descending (LAD) lesions have more myocardium at risk and worse outcomes than those located in other segments. The aim is to compare outcomes of patients with STEMI and proximal-LAD lesions treated with bare-metal stents (BMS) versus everolimus-eluting stents (EES).
Methods |
The EXAMINATION trial randomized 1498 STEMI patients to BMS versus EES. The primary end point was the patient-oriented combined of all-cause death, any-recurrent myocardial infarction (MI) and any-revascularization. The secondary end point included the device-oriented combined of cardiac death, target-vessel MI and target-lesion revascularization (TLR).
Results |
STEMI with a proximal-LAD occlusion was observed in 290 patients (BMS = 132 and EES = 158). Both groups were similar except for diabetes (12.9% vs 24.1%; P = .016). At 1 year, the primary end point was observed in 18.9% and 9.5% of patients treated with BMS and EES, respectively (P = .023). The secondary end point was observed in 11.4% and 5.1%, respectively (P = .053). There were no differences in cardiac death (4.5% vs 3.8%; P = .750) and MI (1.5% vs 0%; P = .121). BMS had higher rate of TLR compared to EES (6.8% vs 1.3%; P = .014).
Patients with proximal-LAD STEMI had higher mortality than patients with non proximal-LAD STEMI (5.5% vs 2.9%; P = .027). Proximal-LAD lesions treated with BMS tended to increase the risk of the primary end point compared with other segments (18.9% vs 13.0%; P = .079). However, EES implanted in proximal-LAD had similar outcomes compared with other locations (9.5% vs 12.0%; P = .430). Adjusting for confounders, the interaction between BMS and proximal-LAD location was associated with the primary end point.
Conclusion |
Patients with STEMI and proximal-LAD lesions treated with EES have better outcomes compared with BMS at 1 year. Although further investigations are required, it seems reasonable to consider EES for proximal-LAD STEMI-lesions.
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Vol 166 - N° 1
P. 119 - juillet 2013 Retour au numéro
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