Long-term Clinical and Angiographic Outcomes after Primary Stenting for ST Segment Elevation Myocardial Infarction Using a Paclitaxel-Eluting Stent: A Propensity Score-Matched Comparison with Bare-Metal Stents (Original)

Objective : The long-term outcomes after primary stenting for patients with ST segment elevation myocardial infarction (STEMI) with paclitaxel-eluting stents (PESs : composed of TAXUS Express and TAXUS Liberte) in Japan where severe cardiac events are infrequent were compared with those for bare-metal stents (BMSs). Methods : This retrospective, nonrandomized, single-center study was conducted in October 2013. STEMI patients treated with primary stenting using PESs (n=238) and BMSs (n=171) between September 2004 and December 2011 were enrolled. Baseline variables were adjusted using a propensity score-matched analysis. Results : Among 194 baseline-adjusted patients who produced similar mean maximum balloon sizes (BMS, 3.51±0.46 mm ; PES, 3.51±0.41 mm ; p=0.993), the incidence of the clinical endpoint comprising cardiac death, nonfatal recurrent myocardial infarction, and definite stent thrombosis was not significantly different after PES placement (5.2% ; mean follow-up, 1,378±576 days) or after BMS placement (7.2% ; 1,120±576 days) (p=0.564). In 156 baseline-adjusted patients, the incidence of the angiographic endpoint (binary in-stent restenosis : % diameter stenosis >50% on secondary angiography) was significantly lower after PES placement (12.8% ; mean follow-up, 413±220 days) than after BMS placement (28.2%, 236±88 days) (p=0.019). PES was the only predictor of binary in-stent restenosis (odds ratio : 0.31, 95% confidence interval [CI] : 0.12-0.80, p=0.015). Conclusion : The present study is the first to show the long-term equivalent clinical safety with superior angiographic outcomes of PES compared with BMS for primary stenting in Japanese daily clinical practice, although the balloon size was large. (Jikeikai Med J 2014 ; 61 : 77-86)