• Lorenz Räber, Henning Kelbæk, Miodrag Ostojic, Miodrag Ostoijc, Andreas Baumbach, Dik Heg, David Tüller, Clemens von Birgelen, Marco Roffi, Aris Moschovitis, Ahmed A Khattab, Peter Wenaweser, Robert Bonvin... more i, Giovanni Pedrazzini, Ran Kornowski, Klaus Weber, Sven Trelle, Thomas F Lüscher, Masanori Taniwaki, Christian M Matter, Bernhard Meier, Peter Jüni, Stephan Windecker, and COMFORTABLE AMI Trial Investigators. less
• Department of Cardiology, Bern University Hospital, Bern, Switzerland.
• JAMA. 2012 Aug 22;308(8):777-87.

ContextThe efficacy and safety of drug-eluting stents compared with bare-metal stents remains controversial in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).ObjectiveTo compare stents eluting biolimus from a biodegradable polymer with bare-metal stents in primary PCI.Design, Setting, And PatientsA prospective, randomized, single-blinded, controlled trial of 1161 patients presenting with STEMI at 11 sites in Europe and Israel between September 19, 2009, and January 25, 2011. Clinical follow-up was performed at 1 and 12 months.InterventionPatients were randomized 1:1 to receive the biolimus-eluting stent (n = 575) or the bare-metal stent (n = 582).Main Outcome MeasuresPrimary end point was the rate of major adverse cardiac events, a composite of cardiac death, target vessel-related reinfarction, and ischemia-driven target-lesion revascularization at 1 year.ResultsMajor adverse cardiac events at 1 year occurred in 24 patients (4.3%) receiving biolimus-eluting stents with biodegradable polymer and 49 patients (8.7%) receiving bare-metal stents (hazard ratio [HR], 0.49; 95% CI, 0.30-0.80; P = .004). The difference was driven by a lower risk of target vessel-related reinfarction (3 [0.5%] vs 15 [2.7%]; HR, 0.20; 95% CI, 0.06-0.69; P = .01) and ischemia-driven target-lesion revascularization (9 [1.6%] vs 32 [5.7%]; HR, 0.28; 95% CI, 0.13-0.59; P < .001) in patients receiving biolimus-eluting stents compared with those receiving bare-metal stents. Rates of cardiac death were not significantly different (16 [2.9%] vs 20 [3.5%], P = .53). Definite stent thrombosis occurred in 5 patients (0.9%) treated with biolimus-eluting stents and 12 patients (2.1%; HR, 0.42; 95% CI, 0.15-1.19; P = .10) treated with bare-metal stents.ConclusionCompared with a bare-metal stent, the use of biolimus-eluting stents with a biodegradable polymer resulted in a lower rate of the composite of major adverse cardiac events at 1 year among patients with STEMI undergoing primary PCI.Trial Registrationclinicaltrials.gov Identifier: NCT00962416.

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