Drug-eluting Versus Bare-Metal Stents in Primary PCI. Analysis of an 8-Year Registry

Introduction and objectives: Evidence of the long-term prognostic benefit of new-generation drug-eluting stents (DES) is limited, especially in the context of primary percutaneous coronary interventions. The goal of this study was to compare the long-term prognostic impact of the implantation of DES versus bare-metal stents (BMS) in real-world patients undergoing primary percutaneous coronary interventions. Methods: A cohort study was conducted with 1499 consecutive patients diagnosed with ST-segment elevation myocardial infarction who underwent percutaneous coronary interventions between January 2008 and December 2015. A total of 24.9% of the patients received a DES. A matched propensity score analysis yielded 2 groups of 262 matched patients depending on whether they were treated with a DES or a BMS. Results: During follow-up (median 1015 days), the patients who received DES had a lower all-cause mortality rate (6.5% vs 12.2%; P =.049), a lower composite endpoint of major adverse cardiac events (16.4% vs 25.2%; P =.049) and a lower patient-oriented composite endpoint of death from any cause, myocardial infarction and revascularization at follow-up (12.6% vs 22.5%; P =.017). No differences were seen in the definite stent thrombosis rate. Conclusions: In our registry, in a real-world population of consecutive patients undergoing primary percutaneous coronary interventions, the use of DES versus BMS associated more survival and less clinically significant major adverse cardiac events and patient-oriented composite endpoints in a long-term follow-up, without any differences in stent thrombosis.