• Int. J. Cardiol. · Sep 2013

    Comparative Study

    Comparison of long-term outcomes in STEMI and NSTE-ACS after coronary stent placement: an analysis in a real world BMS and DES population.

    • Maarten A H van Leeuwen, Joost Daemen, Nicolas M van Mieghem, Sanneke P M de Boer, Eric Boersma, Robert J van Geuns, Felix Zijlstra, Ron T van Domburg, Patrick W J C Serruys, and Interventional Cardiologists of the Thoraxcenter 2000–2009.
    • Department of Cardiology, Erasmus MC, Thoraxcenter, Rotterdam, the Netherlands. m.a.h.vanleeuwen@erasmusmc.nl
    • Int. J. Cardiol. 2013 Sep 1; 167 (5): 2082-7.

    Background/ObjectivesThe prognostic difference between STEMI and NSTE-ACS after coronary stent placement remains unclear. We aimed to compare the short- and long-term event rates in patients presenting with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI) with either bare-metal stents (BMS) or drug-eluting stents (DES).MethodsBetween 2000 and 2005 a total of 1749 STEMI and 1921 NSTE-ACS patients received either a BMS or DES in consecutive real world cohorts. Descriptive statistics and multivariate survival analyses were applied to compare the event rates in STEMI and NSTE-ACS during 4 years follow-up.ResultsNSTE-ACS patients had significantly higher clinical and angiographic risk profiles at baseline and were treated with less optimal medical therapy during follow-up. At 4 years follow-up, all-cause mortality was significantly higher in STEMI compared to NSTE-ACS after coronary stent placement (17.4% vs. 14.3%; HR 1.60, 95% CI 1.24-2.07). In a landmark analysis no difference was seen in all-cause mortality among STEMI en NSTE-ACS between 1 month and 4 years follow-up (HR 1.10, 95% CI 0.81-1.51). Cardiac death was more prevalent in STEMI patients, while the 4-year cumulative incidences of any myocardial infarction, any coronary revascularization, target lesion revascularization and definite stent thrombosis were similar in both ACS groups.ConclusionsPatients presenting with STEMI have a worse long-term prognosis compared to NSTE-ACS after coronary stent placement, due to higher short-term death rates. However, after the first month STEMI and NSTE-ACS patients have a comparable long-term survival.Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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