Five-year outcomes of ST-elevation myocardial infarction versus non-ST-elevation acute coronary syndrome treated with biodegradable polymer-coated sirolimus-eluting stents: Insights from the CREATE trial.
BACKGROUND
Long-term outcome of drug-eluting stents (DES) for ST-elevation myocardial infarction (STEMI) versus non-ST-elevation acute coronary syndrome (NSTE-ACS) remains unclear. This study sought to compare the long-term outcomes of biodegradable polymer-coated DES in patients with STEMI versus NSTE-ACS.


METHODS
We explored a post hoc analysis of the 5-year outcome of the CREATE trial in the subgroup of patients with STEMI (n=318) versus NSTE-ACS (n=1223) who were implanted with biodegradable polymer-coated DES. The primary outcome was the rate of major adverse cardiac events (MACE) at 5 years. Clopidogrel and aspirin for 6 months followed by chronic aspirin therapy were recommended.


RESULTS
STEMI patients showed a trend of increase in MACE (8.7% vs. 6.8%, log rank p=0.289) compared to NSTE-ACS patients at 5 years, and a greater risk of cardiac death (5.4% vs. 2.1%, log rank p=0.003), mainly driven by the higher cardiac death rate within the first month after stent placement (log rank p=0.003) and the last year of follow-up (log rank p=0.001). No significant difference in stent thrombosis was found between them (3.1% vs. 2.5%, log rank p=0.653). Prolonged clopidogrel therapy (>6 months) showed no effect on risk of MACE or stent thrombosis between the two groups (both p for interaction >0.1).


CONCLUSIONS
STEMI patients have a higher risk of cardiac mortality compared with NSTE-ACS patients after biodegradable polymer-coated DES placement, primarily attribute to more cardiac deaths that happened within the first month after the event and the last year of follow-up.
['Liu|Hui-Liang|HL|', 'Jin|Zhi-Geng|ZG|', 'Yang|Sheng-Li|SL|', 'Han|Wei|W|', 'Jing|Quan-Min|QM|', 'Zhang|Lei|L|', 'Luo|Jian-Ping|JP|', 'Ma|Dong-Xing|DX|', 'Liu|Ying|Y|', 'Yang|Li-Xia|LX|', 'Jiang|Tie-Min|TM|', 'Qu|Peng|P|', 'Li|Wei-Min|WM|', 'Li|Shu-Mei|SM|', 'Xu|Bo|B|', 'Gao|Run-Lin|RL|', 'Han|Ya-Ling|YL|']
D020341:Absorbable Implants D054058:Acute Coronary Syndrome D000368:Aged D000900:Anti-Bacterial Agents D054855:Drug-Eluting Stents D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D011108:Polymers D000072657:ST Elevation Myocardial Infarction D020123:Sirolimus D013997:Time Factors D016896:Treatment Outcome
Myocardial infarction Acute coronary syndrome Biodegradable polymer Drug eluting stent