[Long-term clinical and angiographic follow-up of drug-eluting stents in patients with ST-elevation acute myocardial infarction]. / Resultados clínicos y angiográficos tardíos de stents liberadores de fármacos en pacientes con infarto agudo de miocardio con elevación del ST.

INTRODUCTION AND OBJECTIVES: Drug-eluting stents (DES) have proven to be effective in reducing the rate of restenosis and have, therefore, been incorporated into the treatment of patients with ST-elevation acute myocardial infarction (STEMI). The aim of this study was to investigate long-term clinical and angiographic outcomes following the use of DESs in patients with STEMI. METHODS: A prospective study involving clinical and angiographic follow-up was performed in 81 patients with STEMI who underwent percutaneous coronary intervention including DES implantation. This group was compared with 82 patients with similar characteristics who were treated with bare-metal stents (BMS) in an earlier period. RESULTS: At one year, there was no significant difference between the groups in the mortality (2.5% in the DES group vs 7.3% in the BMS group; P=.15) or reinfarction rate (4.8% in the DES group vs. 4.8% in the BMS group; P=.98). The target lesion revascularization rate was significantly lower in the DES group (8.6% vs 23.2% in the BMS group; P=.001), as was the restenosis rate (13.8% vs. 30.9% in the BMS group; P=.02). Acute or subacute stent thrombosis was diagnosed in five patients (3 with a DES and 2 with a BMS; P=.64), and one late stent thrombosis was detected after a year, in a sirolimus-eluting stent. CONCLUSIONS: Implantation of a DES in patients with STEMI did not result in a reduction in either the mortality or reinfarction rate at 1 year compared with BMS implantation. However, there were reductions in the rates of restenosis and target lesion revascularization. The incidence of thrombosis was similar with the two types of stent.

Resultados clínicos y angiográficos tardíos de stents liberadores de fármacos en pacientes con infarto agudo de miocardio con elevación del ST / Long-term clinical and angiographic follow-up of drug-eluting stents in patients with ST-elevation acute myocardial infarction

Introducción y objetivos. Los stents liberadores de fármacos (SLF) han demostrado reducir la reestenosis y por ello se han incorporado al tratamiento de pacientes con infarto agudo de miocardio con elevación del ST (IAMEST). En este trabajo se han evaluado los resultados clínicos y angiográficos a largo plazo de los SLF en pacientes con IAMEST. Métodos. Se realizó prospectivamente un seguimiento clínico y angiográfico de 81 pacientes con IAMEST sometidos a intervencionismo coronario percutáneo con implante de SLF. Este grupo se comparó con otro de 82 pacientes con características similares, tratados con stents convencionales (SC) en un período anterior. Resultados. Al año no hubo diferencias significativas en las tasas de mortalidad (2,5% en el grupo SLF y 7,3% en el grupo SC; p = 0,15) o reinfarto (4,8% del grupo SLF y 4,8% del grupo SC; p = 0,98). La necesidad de nueva revascularización de la lesión fue menor en el grupo SLF (8,6 y 23,2%; p = 0,001) al igual que la tasa de reestenosis (13,8% del grupo SLF y 30,9% del grupo SC; p = 0,02). Se registraron 5 trombosis agudas o subagudas de stent (3 SLF y 2 SC; p = 0,64) y una tardía después del año en un stent de sirolimus. Conclusiones. El implante de SLF en pacientes con IAMEST no reduce la mortalidad o el reinfarto al año respecto a los SC; sin embargo, reduce la tasa de reestenosis y la necesidad de nueva revascularización. La incidencia de trombosis de stent fue similar en los dos grupos

Introduction and objectives. Drug-eluting stents (DES) have proven to be effective in reducing the rate of restenosis and have, therefore, been incorporated into the treatment of patients with ST-elevation acute myocardial infarction (STEMI). The aim of this study was to investigate long-term clinical and angiographic outcomes following the use of DESs in patients with STEMI. Methods. A prospective study involving clinical and angiographic follow-up was performed in 81 patients with STEMI who underwent percutaneous coronary intervention including DES implantation. This group was compared with 82 patients with similar characteristics who were treated with bare-metal stents (BMS) in an earlier period. Results. At one year, there was no significant difference between the groups in the mortality (2.5% in the DES group vs 7.3% in the BMS group; P=.15) or reinfarction rate (4.8% in the DES group vs. 4.8% in the BMS group; P=.98). The target lesion revascularization rate was significantly lower in the DES group (8.6% vs 23.2% in the BMS group; P=.001), as was the restenosis rate (13.8% vs. 30.9% in the BMS group; P=.02). Acute or subacute stent thrombosis was diagnosed in five patients (3 with a DES and 2 with a BMS; P=.64), and one late stent thrombosis was detected after a year, in a sirolimus-eluting stent. Conclusions. Implantation of a DES in patients with STEMI did not result in a reduction in either the mortality or reinfarction rate at 1 year compared with BMS implantation. However, there were reductions in the rates of restenosis and target lesion revascularization. The incidence of thrombosis was similar with the two types of stent

[Stent thrombosis in the modern era: incidence, outcome and predictive factors]. / Trombosis del stent en la era moderna: incidencia, consecuencias y factores predictores.

Coronary stent thrombosis is a catastrophic complication of percutaneous coronary intervention. Its incidence is reported to be about 1%, though it can occur more frequently in high-risk patients, in high-risk lesions, and in multivessel procedures. We investigated the occurrence of stent thrombosis in 404 consecutive patients in a period when conventional and drug-eluting stents were both being used. We found an overall incidence of 2.23%, a mortality rate of 22.2%, and a non-fatal myocardial infarction rate of 66.6%. Predictors of stent thrombosis were acute myocardial infarction, multiple stent placement, poor ejection fraction, small stent diameter, the presence of residual dissection, and premature discontinuation of clopidogrel.

Trombosis del stent en la era moderna: incidencia, consecuencias y factores predictores / Stent Thrombosis in the Modern Era: Incidence, Outcome and Predictive Factors

La trombosis del stent (TS) es una complicación temida del intervencionismo coronario percutáneo por sus consecuencias catastróficas, cuya incidencia aproximada es del 1% y que puede ser más frecuente en procedimientos realizados en pacientes/lesiones de alto riesgo o procedimientos multivaso. Analizamos la aparición de TS en una población de 404 pacientes consecutivos en un período en el que se utilizaron tanto stents recubiertos como stents convencionales, con una incidencia global del 2,23%, una mortalidad del 22,2% y una tasa de infarto agudo de miocardio no fatal del 66,6%. Los factores predictores de aparición de TS fueron: indicación por infarto agudo de miocardio, implante de múltiples stents, peor fracción de eyección, diámetro de stent más pequeño, presencia de disección residual y abandono precoz de clopidogrel (AU)

Coronary stent thrombosis is a catastrophic complication of percutaneous coronary intervention. Its incidence is reported to be about 1%, though it can occur more frequently in high-risk patients, in high-risk lesions, and in multivessel procedures. We investigated the occurrence of stent thrombosis in 404 consecutive patients in a period when conventional and drug-eluting stents were both being used. We found an overall incidence of 2.23%, a mortality rate of 22.2%, and a non- fatal myocardial infarction rate of 66.6%. Predictors of stent thrombosis were acute myocardial infarction, multiple stent placement, poor ejection fraction, small stent diameter, the presence of residual dissection, and premature discontinuation of clopidogrel (AU)