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

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• 作者：Hui-liang Liu ; MD ; PhD^a ; ¹ ; Zhi-geng Jin ; MD^a ; ¹ ; Sheng-li Yang ; MD ; PhD^a ; Wei Han ; MD^a ; Quan-min Jing ; MD^b ; Lei Zhang ; MD^b ; Jian-ping Luo ; MD^a ; Dong-xing Ma ; MD^a ; Ying Liu ; MD^a ; Li-xia Yang ; MD ; PhD^c ; Tie-min Jiang ; MD ; PhD^d ; Peng Qu ; MD ; PhD^e ; Wei-min Li ; MD ; PhD^f ; Shu-mei Li ; MD ; PhD^g ; Bo Xu ; MBBS^h ; Run-lin Gao ; MD ; PhD^h ; Ya-ling Han ; MD ; PhD^b ; ^{yalinghan_nh@126.com}
• 关键词：Drug eluting stent ; Myocardial infarction ; Acute coronary syndrome ; Biodegradable polymer
• 刊名：Journal of Cardiology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：69
• 期：1
• 页码：149-155
• 全文大小：901 K
• 卷排序：69

文摘

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.MethodsWe 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.ResultsSTEMI 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).ConclusionsSTEMI 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.