Summary
Background: Limited data are available for sirolimus eluting stent (SES) implantation in patients with ST-segment elevation myocardial infarction (STEMI). Aim: to confirm the safety and effectiveness of SES in patients with STEMI in a real-world scenario (multicentric registry). Methods: From July 2002 to June 2004, clinical and angiographic data of 1617 patients with STEMI treated with primary percutaneous coronary intervention (PCI) have been collected. Patients were prospectively followed for the occurrence of major adverse cardiac events (MACE): death, reinfarction and target vessel revascularization (TVR). Results: Overall, 205 patients received SES (12.5%, SES group) and 1412 received bare metal stent (87.5%, BMS group) in the infarct related artery. Compared with the BMS group, SES patients were younger, had more often diabetes mellitus, anterior localization and less cardiogenic shock at admission. The angiographic characteristics in the SES group showed longer lesions and smaller diameter of vessels. After a median follow-up of 396 days, there was no significant difference in the rate of stent thrombosis (1% in the SES group vs 1.5% in the BMS group, p=ns). The incidence of MACE was significantly lower in the SES group compared to BMS group (HR 0.62 [95% CI: 0.4–0.95]; p=0.03), principally due to the lower rate of TVR (HR 0.41 [95% CI: 0.2–0.85]; p=0.01). Conclusions: Utilization of SES in the setting of primary PCI for STEMI, in our “real world” registry, was safe and improved the 1-year clinical outcome compared to BMS reducing the need of TVR.
Similar content being viewed by others
References
Topol EJ, Neumann FJ, Montalescot G. A preferred reperfusion strategy for acute myocardial infarction. J Am Coll Cardiol 2003;42:1886–1889.
Moses JW, Leon MB, Popma JJ, et al. For the SIRIUS Investigators. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 2003;349:1315–1323.
Schofer J, Schluter M, Gershlick AH, et al. For the E-SIRIUS Investigators. Sirolimus-eluting stents for treatment of patients with long atherosclerotic lesions in small coronary arteries: Double-blind, randomised controlled trial (E-SIRIUS). Lancet 2003;362:1093–1099.
Lemos PA, Lee C, Degertekin M, et al. Early outcome after sirolimus-eluting stent implantation in patients with acute coronary syndromes. J Am Coll Cardiol 2003;41:2093–2099.
Lemos PA, Saia F, Hofma SH, et al. Short- and long-term clinical benefit of sirolimus-eluting stents compared to conventional bare stents for patients with acute myocardial infarction. J Am Coll Cardiol 2004;43:704–708.
Saia F, Lemos PA, Lee CH, et al. Sirolimus-eluting stent implantation in ST-elevation acute myocardial infarction: A clinical and angiographic study. Circulation 2003;108:1927–1929.
Valgimigli M, Percoco G, Cicchitelli G, et al. Highdose bolus tirofiban and sirolimus eluting stent versus abciximab and bare metal stent in acute myocardial infarction (STRATEGY) study—protocol design and demography of the first 100 patients. Cardiovasc Drugs Ther 2004;18:225–230.
Valgimigli M, Percoco G, Malagutti P, et al. Tirofiban and sirolimus-eluting stent vs abciximab and bare-metal stent for acute myocardial infarction. A randomized trial. JAMA 2005;293:2109–2117.
Marzocchi A, Piovaccari G, Manari A, et al. Comparison of effectiveness of sirolimus-eluting stents versus bare metal stents for percutaneous coronary intervention in patients at high risk for coronary restenosis or clinical adverse events. Am J Cardiol 2005;95:1409–1414.
TIMI study group. The thrombolysis in myocardial infarction (TIMI) trial. Phase I findings. N Engl J Med 1985;312: 932–936.
Weber F, Schneider H, Schwarz C, Holzhausen C, Petzsch M, Nienaber CA. Sirolimus-eluting stents for percutaneous coronary intervention in acute myocardial infarction. Z Kardiol 2004;93:938.
Moreno R, Fernandez C, Hernandez R, et al. Drug-eluting stent thrombosis. Results from a pooled analysis including 10 randomized studies. J Am Coll Cardiol 2005;45:954–959.
Eisenberg MJ, Jamal S. Glycoprotein IIb/IIIa inhibition in the setting of acute ST-segment elevation myocardial infarction. J Am Coll Cardiol 2003;42:1–6.
Montalescot G, Barragan P, Wittenberg O, et al. Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction. N Engl J Med 2001;344:1895–1903.
Buiatti E, Barchielli A, Marchionni N, et al. Determinants of treatment strategies and survival in acute myocardial infarction: A population-based study in the Florence district, Italy. Eur Heart J 2003;24:1195–1203.
Antoniucci D, Rodriguez A, Hempel A, et al. A randomized trial comparing primary infarct artery stenting with or without abciximab in acute myocardial infarction. J Am Coll Cardiol 2003;42:1879–1885.
Neumann F-J, Kastrati A, Schmitt C, et al. Effect of glycoprotein IIb/IIIa receptor blockade with abciximab on clinical and angiographic restenosis rate after the placement of coronary stents following acute myocardial infarction. J Am Coll Cardiol 2000;35:915–921.
Author information
Authors and Affiliations
Consortia
Corresponding author
Rights and permissions
About this article
Cite this article
Percoco, G., Manari, A., Guastaroba, P. et al. Safety and Long-Term Efficacy of Sirolimus Eluting Stent in ST-elevation Acute Myocardial Infarction: The REAL (Registro REgionale AngiopLastiche Emilia-Romagna) Registry. Cardiovasc Drugs Ther 20, 63–68 (2006). https://doi.org/10.1007/s10557-006-6753-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10557-006-6753-9