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| Meeting: | Scientific Sessions 2005 | | Session Number: | APS.73.3 | | Session Title: | Catheter-Based Coronary Interventions: Drug-Eluting Stents | | Presentation Number: | 2303 | | Presentation Title: | Paclitaxel and Sirolimus Stent Implantation in Patients with Acute Myocardial Infarction | | Author Block: | Emilio Di Lorenzo, Attilio Varricchio, Tonino Lanzillo, Rosario Sauro, Gian Michele Cianciulli, Fiore Manganelli, Ciro Mariello, Francesco Siano, Maria Rosaria Pagliuca, Giovanni Stanco, Giuseppe Rosato, Division of Cardiology AO MOSCATI, AVELLINO, Italy | | Disclosure Block: | E. Di Lorenzo, None; A. Varricchio, None; T. Lanzillo, None; R. Sauro, None; G. Cianciulli, None; F. Manganelli, None; C. Mariello, None; F. Siano, None; M. Pagliuca, None; G. Stanco, None; G. Rosato, None. | | Abstract Body: | Routine stent implantation has been advocated for patients with acute myocardial infarction (AMI) referred for primary angioplasty with superior results compared to balloon dilatation. However the late clinical efficacy is still hampered by the occurrence of in stent restenosis and the need of repeat intervention. The clinical impact of drug eluting stents implantation for patients with AMI is currently unknown. This study investigated, for the first time, the feasibility, the safety and the clinical outcomes of patients with ST-segment elevation myocardial infarction (AMI) treated with paclitaxel-eluting stents (PES) or sirolimus eluting stent (SES). From 1 November 2003 to 1 December 2004 we randomized with 1:1:1 ratio, 180 patients with AMI and treated with primary PTCA, to implantation of a bare metal stent (BMS n=60), PES (n=60) or SES (n=60). All patients received glycoprotein IIb/IIIa inhibitors, standard doses of unfractionated heparin and aspirin before angioplasty. Postinterventional antiplatelet theraphy consisted of aspirin (100 mg) indefinitely and clopidogrel (75 mg for six months). The cumulative incidence of death, reinfarction, and Target Vessel Revascularization (TVR) was assessed at 30 days and 6 months. The incidence of short-term adverse events were similar in the three study group (30 day rate of death, reinfarction, and TVR: BMS 3.4%, PES 2.6%, SES 2.9% respectively; NS). Early or late stent thrombosis was not diagnosed in any patient in the three groups. At 6 months PES and SES implantation significantly reduced the incidence of combined adverse events (BMS 23.6%, PES 8.1%, SES 6.4% respectively; p<0.05 vs BMS). Because death and reinfarction were similar between groups, this difference was driven mainly to a marked reduction in the risk of repeat intervention (BMS 15.6%, PES 1.5%, SES 0%; p<0.01 vs BMS). Our data shown that implantation of drug eluting stents is feasible and safe in patients with AMI. In fact, compared to conventional bare stents, PES and SES were not associated with an increased risk of stent thrombosis and were effective in reducing the incidence of adverse events at 6 months in patients with AMI referred for primary angioplasty. |
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