Does Large Vessel Size Justify Use of Bare-Metal Stents in Primary Percutaneous Coronary Intervention? Insights From the EXAMINATION Trial


Por: Costa, F, Brugaletta, S, Pernigotti, A, Flores-Ulmanzor, E, Ortega-Paz, L, Cequier, A, Iniguez, A, Serra, A, Jimenez-Quevedo, P, Mainar, V, Campo, G, Tespili, M, den Heijer, P, Bethencourt, A, Vazquez, N, van Es, GA, Backx, B, Valgimigli, M, Serruys, P, Sabate, M

Publicada: 1 sep 2019
Resumen:
Background: Drug-eluting stents (DES) showed improved efficacy and safety compared with bare-metal stents (BMS), and international guidelines recommend their use as first line treatment. Yet, BMS are still widely used in practice, especially in large coronary vessels. We aimed to compare efficacy and safety of second-generation DES over BMS in large coronary culprit ST-segment elevated myocardial infarction lesions. Methods: We evaluated impact of large coronary stents (maximum size >= 3.50 mm) or smaller stents (<3.50 mm), among 1498 patients with ST-segment elevated myocardial infarction undergoing primary percutaneous coronary intervention, randomly allocated to everolimus-eluting DES or to an equivalent BMS platform in the EXAMINATION trial (Clinical Evaluation of the Xience-V Stent in Acute Myocardial Infarction Trial). Clinical events up to 5 years of follow-up were evaluated. Results: Large coronary stents were used in 683 patients (45.9%). At 5-year follow-up, the crude rate of the primary end point, a composite of all-cause death, any myocardial infarction, or any revascularization, was similar among patients treated with large or smaller coronary stents. The impact of DES versus BMS implantation was consistent irrespective of the stent size both for the primary end point (P-int=0.82) and other secondary ischemic end points. Within patients treated with bigger stents, DES implantation was associated to a trend toward a reduction of target lesion (hazard ratio, 0.53; 95% CI, 0.27-1.02; P=0.05) and target vessel revascularization (hazard ratio, 0.60; 95% CI, 0.34-1.03; P=0.066). Conclusions: Our results do not support the preferential use of BMS for patients with large coronary vessels. DES may warrant improved efficacy irrespective of stent size among patients undergoing primary percutaneous coronary intervention.

Filiaciones:
Costa, F:
 Hosp Clin Barcelona, Inst Clin Cardiovasc ICCV, Inst Invest Biomed August Pi & Sunyer IDIBAP, Barcelona, Spain

 Univ Messina, Dept Clin & Expt Med, Messina, Italy

 Hosp Univ Bellvitge, Lhospitalet De Llobregat, Spain

Pernigotti, A:
 Hosp Clin Barcelona, Inst Clin Cardiovasc ICCV, Inst Invest Biomed August Pi & Sunyer IDIBAP, Barcelona, Spain

Flores-Ulmanzor, E:
 Hosp Clin Barcelona, Inst Clin Cardiovasc ICCV, Inst Invest Biomed August Pi & Sunyer IDIBAP, Barcelona, Spain

Ortega-Paz, L:
 Hosp Clin Barcelona, Inst Clin Cardiovasc ICCV, Inst Invest Biomed August Pi & Sunyer IDIBAP, Barcelona, Spain

Iniguez, A:
 Hosp Alvaro Cunqueiro Vigo, Vigo, Spain

 Hosp Santa Creu & Sant Pau, Barcelona, Spain

Jimenez-Quevedo, P:
 Univ Hosp San Carlos, Madrid, Spain

Mainar, V:
 Hosp Gen Alicante, Alicante, Spain

Campo, G:
 Azienda Osped Univ Ferrara, Cona, FE, Italy

 Maria Cecilia Hosp, GVM Care & Res, Cotignola, RA, Italy

Tespili, M:
 Univ Hosp Bolognini Senate, Bergamo, Italy

den Heijer, P:
 Amphia Ziekenhuis, Breda, Netherlands

Bethencourt, A:
 Hosp Son Espases, Palma De Mallorca, Spain

Vazquez, N:
 Hosp Juan Canalejo, La Coruna, Spain

van Es, GA:
 Cardialysis, Rotterdam, Netherlands

Backx, B:
 Cardialysis, Rotterdam, Netherlands

Valgimigli, M:
 Univ Hosp Bern, Inselhosp, Bern, Switzerland

Serruys, P:
 Imperial Coll London, London, England

Sabate, M:
 Hosp Clin Barcelona, Inst Clin Cardiovasc ICCV, Inst Invest Biomed August Pi & Sunyer IDIBAP, Barcelona, Spain
ISSN: 19417640





Circulation-Cardiovascular Interventions
Editorial
LIPPINCOTT WILLIAMS & WILKINS, TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA, Estados Unidos America
Tipo de documento: Article
Volumen: 12 Número: 9
Páginas:
WOS Id: 000486309600003
ID de PubMed: 31451013
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