Comparação dos stents farmacológicos vs. stents convencionais com supradesnivelamento do segmento ST: resultados do registro EINSTEIN / Long-Term Outcomes of Drug-eluting Stents Compared to Bare-metal Stents for Acute STElevation Myocardial Infarction: Results from the EINSTEIN Registry

RESUMO

Fundamentos Os estudos randomizados que testaram os stents farmacológicos no infarto agudo do miocárdio com supradesnivelamento do seguimento ST (IAMSST) demostraram resultados conflitantes. Além disso, a trombose do stent e o seguimento tardio pouco reportado permanecem como os grandes limitantes à expansão da aplicação desses dispositivos no IAMSST. Objetivo: Comparar as taxas de eventos cardíacos adversos maiores combinados (ECAM) e as taxas de trombose do stent em pacientes não-selecionados tratados com stents convencionais ou farmacológicos no IAMSST e alocados de forma não-randômica. Método: Entre janeiro de 2001 e julho de 2007, 251 pacientes consecutivos com IAMSST foram submetidos a angioplastia primária ou de resgate com implante de stent convencional (n= 112) ou farmacológico (n= 139), no Hospital Israelita Albert Einstein - São Paulo, SP. Investigamos a incidência de ECAM (óbito, infarto do miocárdio e revascularização do vaso-alvo (RVA) e as taxas de [RVA]) e trombose do stent. Resultados: No total, a média das idades foi de 63 + - 13 anos, sendo 77 por cento dos pacientes do sexo masculino . No seguimento mediano de 2,8 anos (1,2-4,4), a incidência de ECAM foi maior nos pacientes tratados com stents convencionais...

ABSTRACT

Background: Randomized clinical trials comparing drugeluting stents (DES) with bare metal stents (BMS) in the setting of ST-segment elevation myocardial infarction (STEMI) have been showing conflicting results. Additionally, issues regarding stent thrombosis and the lack of long-term clinical outcomes have limited the widespread use of DES in STEMI. Objective: To compare the rates of major adverse cardiac events (MACE) and stent thrombosis in unselected patients who underwent primary or rescue percutaneous coronary intervention with BMS implantation with those treated with DES. Methods: Between January 2001 and July 2007, 251 consecutive patients with STEMI underwent PCI with BMS (n = 112) or DES (n =139). We investigated the incidence of MACE, including death, myocardial infarction and target vessel revascularization (TVR), as well as stent thrombosis rates. Results: Overall, the mean age was 63 ± 13 years-old and 77% were male. The median clinical follow-up was 2.8 years (1.3-4.4). The cumulative incidence of MACE was higher in patients who received BMS as compared with DES (25.2% vs. 10.1%; p < 0.01) driven by a higher incidence of all-cause mortality (17.8% vs. 5.1%; p < 0.01), mainly cardiac death (15.9 vs. 4.3; p < 0.01). TVR was detected in 8 patients (7.5%) with BMS and in 5 patients (3.6%) with DES (p = 0.25). The incidence of stent thrombosis was similar between groups (3.7% vs. 2.2%; p = 0.7). Conclusions: In this observational series, the use of DES in the setting of STEMI showed lower rates of MACE compared to BMS at the long-term follow-up.