Comparison of the Mid-Term Outcome between Drug-Eluting Stent and Bare Metal Stent Implantation in Patients Undergoing Primary PCI in Rajaie Heart Center January 2012- April 2013

Early reperfusion therapy is a life-saving treatment for patients with ST-segment elevation myocardial infarction. Primary percutaneous coronary intervention (PCI) is the preferred method of re-perfusion. A previous meta–analysis of patients undergoing primary PCI has shown the benefits of stenting over balloon angioplasty alone in terms of reducing target vessel revascularization (TVR), although no definite impact on death and re-infarction was present. Several randomized trials have been conducted so far on the drug-eluting stent (DES) in ST-elevation myocardial infarction (STEMI), and long-term follow-up data have recently been published. According to these studies, the use of the DES in comparison to the bare-metal stent (BMS) has reduced TVR without a significant impact on reducing mortality and myocardial re-infarction. In this historical cohort study, patients with STEMI were randomly assigned to either DES (n=51) or BMS (n=333) implantation and the results were evaluated. The primary clinical end points were death, myocardial re-infarction, and need for TVR including coronary artery bypass graft surgery (CABG) or repeat PCI either at the time of the initial procedure or during the subsequent 6 months. In this study, 384 patients with STEMI undergoing primary angioplasty and stent implantation between January 2010 and 2011 were enrolled. The patients were divided into BMS (n=333), DES (n=51) groups. Eight patients had in-hospital mortality and 7 patients had death at 6 month's follow-up, all of them in the BMS group. In the DES group, 5 (9.8%) patients had stent thrombosis and re-infarction, 4 had repeat PCI, and one underwent CABG. From the entire 333 patients in the BMS group, 24 (7.2%) had myocardial infarction, 20 (6%) had in-stent re-stenosis, and 15 (4.5%) had stent thrombosis. The TVR rate in the DES group was 9.8% (5 patients) as opposed to 9% (31 patients) in the BMS group. Over all, the MACE rate was 19.6% in the DES group and 21% in the BMS group. There were no significant differences between the DES and BMS groups in terms of TVR and MACE. Over 6 months of follow-up, no significant differences were found between the two groups with respect to death, re-infarction, and TVR and MACE.