Second-Generation DES Safer, More Effective Than BMS in STEMI at 1 Year

MIAMI BEACH, FLA.—In patients with acute ST-segment elevation myocardial infarction (STEMI), second-generation drug-eluting stents (DES) show better safety and efficacy outcomes at 1 year compared with bare metal stents (BMS), according to pooled data from 2 trials presented at TCT 2012.

Manel Sabaté, MD, of the University of Barcelona, Spain, and colleagues analyzed data from 2,665 STEMI patients enrolled in the EXAMINATION and the COMFORTABLE AMI trials. EXAMINATION randomized 1,504 patients to receive an everolimus-eluting stent (EES; Xience V, Abbott Vascular) or BMS. COMFORTABLE AMI randomized 1,161 patients to a biolimus-A9-eluting stent (BioMatrix, Biosensors International) or BMS.

DES show positive 1-year results

At 1 year, patients implanted with DES were at lower risk for both the primary device-oriented composite outcome (cardiac death, TVR and TLR) and the primary patient-oriented composite outcome (death, reinfarction and any revascularization) compared with BMS. Specifically, patients randomized to DES had lower risk of TLR, TVR and definite stent thrombosis within 1 year compared with BMS (see Table).

2nd Gen DES

Acute stent thrombosis was also lower with DES (RR 0.38; 95% CI 0.17-0.85; P=.02).

Green light for new DES in STEMI

According to Sabaté, data from these trials should help physicians overcome any concerns regarding the safety of implanting second-generation DES, even in STEMI patients.

“Most would agree that DES are more efficacious than BMS, namely in that they reduce restenosis,” Sabaté told TCT Daily. “Data from this pooled analysis are reassuring and clearly indicate that second-generation DES are not only efficacious but safe in a highly prothrombotic context such as STEMI, at least up to 1-year follow-up.”

The 2-year results of EXAMINATION will be presented at TCT 2012 on Thursday, October 25. The results should shed light on the long-term safety of EES compared with BMS “beyond the ‘protection’ of dual antiplatelet therapy,” Sabaté said.

Disclosures
  • Dr. Sabaté reports serving as a consultant for Abbott, Cordis and Medtronic.

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