Impact of stent overlapping on long-term clinical outcomes in patients with ST-segment elevation myocardial infarction: Insights from the five-year follow-up of the EXAMINATION trial

Aims: The aim of this study was to compare the long-term outcomes of STEMI patients treated with overlap vs. no-overlap stents. Methods and results: We analysed the one- and five-year clinical outcomes of 1,498 STEMI patients according to overlapping stent implantation. The primary endpoint was a patient-oriented composite endpoint (PoCE) of all-cause death, myocardial infarction, and repeat revascularisation. Stent thrombosis data were also analysed. Four hundred and four (27.0%) patients were treated with overlapping stents, whereas the remaining 1,094 (73.0%) were not. At one and five years, there was no difference in PoCE between the overlap vs. no-overlap group, even after adjustment (14.9% vs. 12.4%; HR 1.20, 95% CI: 0.76-1.90; p=0.44, and 26.3% vs. 22.3%; HR 1.14, 95% CI: 0.80-1.62; p=0.47, respectively). At five years, within the overlap group, patients who received BMS had a trend towards a higher rate of PoCE and DoCE as compared to those who received EES. At one year, there was a trend towards a higher rate of definite/probable stent thrombosis in the overlap compared to the no-overlap group (2.2% vs. 1.6%; HR 2.35, 95% CI: 0.95-5.90; p=0.06). This difference was driven by a higher rate for BMS compared to EES (4.4% vs. 0%, p for interaction=0.03) in the overlap group. At five years, the absolute risk difference for overlap (3.5% vs. 2.2%, p=0.99) and interaction for BMS (p=0.03) were similar. Conclusions: In patients presenting with STEMI, the long-term PoCE was similar for the overlap and no-overlap groups. Overlap among patients receiving BMS appears to be associated with a higher risk for adverse cardiovascular outcomes and stent thrombosis.

Data di pubblicazione: 2017
Titolo: Impact of stent overlapping on long-term clinical outcomes in patients with ST-segment elevation myocardial infarction: Insights from the five-year follow-up of the EXAMINATION trial
Autori: Ortega-Paz, Luis; Brugaletta, Salvatore; Giacchi, Giuseppe; Ishida, Kohki; Cequier, Angel; Iñiguez, Andrés; Serra, Antonio; Jiménez-Quevedo, Pilar; Mainar, Vicente; Campo, Gianluca; Tespili, Maurizio; Den Heijer, Peter; Valgimigli, Marco; Serruys, Patrick W.; Sabaté, Manel; Cutlip, Donald
Rivista: EUROINTERVENTION
Parole Chiave: Bare metal stent; Drug-eluting stent; ST-elevation myocardial infarction; Cardiology and Cardiovascular Medicine
Abstract in inglese: Aims: The aim of this study was to compare the long-term outcomes of STEMI patients treated with overlap vs. no-overlap stents. Methods and results: We analysed the one- and five-year clinical outcomes of 1,498 STEMI patients according to overlapping stent implantation. The primary endpoint was a patient-oriented composite endpoint (PoCE) of all-cause death, myocardial infarction, and repeat revascularisation. Stent thrombosis data were also analysed. Four hundred and four (27.0%) patients were treated with overlapping stents, whereas the remaining 1,094 (73.0%) were not. At one and five years, there was no difference in PoCE between the overlap vs. no-overlap group, even after adjustment (14.9% vs. 12.4%; HR 1.20, 95% CI: 0.76-1.90; p=0.44, and 26.3% vs. 22.3%; HR 1.14, 95% CI: 0.80-1.62; p=0.47, respectively). At five years, within the overlap group, patients who received BMS had a trend towards a higher rate of PoCE and DoCE as compared to those who received EES. At one year, there was a trend towards a higher rate of definite/probable stent thrombosis in the overlap compared to the no-overlap group (2.2% vs. 1.6%; HR 2.35, 95% CI: 0.95-5.90; p=0.06). This difference was driven by a higher rate for BMS compared to EES (4.4% vs. 0%, p for interaction=0.03) in the overlap group. At five years, the absolute risk difference for overlap (3.5% vs. 2.2%, p=0.99) and interaction for BMS (p=0.03) were similar. Conclusions: In patients presenting with STEMI, the long-term PoCE was similar for the overlap and no-overlap groups. Overlap among patients receiving BMS appears to be associated with a higher risk for adverse cardiovascular outcomes and stent thrombosis.
Digital Object Identifier (DOI): 10.4244/EIJ-D-16-00512
Handle: http://hdl.handle.net/11392/2384633
Appare nelle tipologie:03.1 Articolo su rivista

File in questo prodotto:
Non ci sono file associati a questo prodotto.
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
 
 
 
Powered by IRIS-about IRIS-Utilizzo dei cookie
Logo CINECA  Copyright © 2022