Three-Year Outcome of Sirolimus -Eluting Versus Bare-Metal Stents for the Treatment of ST-Segment Elevation Myocardial Infarction (from the MISSION! Intervention Study)

• Published in: The American journal of cardiology Vol. 106; no. 1; pp. 4 - 12
• Main Authors: Atary, Jael Z., MD, van der Hoeven, Bas L., MD, PhD, Liem, Su San, MD, PhD, Jukema, J. Wouter, MD, PhD, van der Bom, Johanna G., MD, PhD, Atsma, Douwe E., MD, PhD, Bootsma, Marianne, MD, PhD, Zeppenfeld, Katja, MD, PhD, van der Wall, Ernst E., MD, PhD, Schalij, Martin J., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2010; Elsevier; Elsevier Limited
• Subjects: Aged; Angioplasty, Balloon, Coronary; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Clinical outcomes; Comparative analysis; Coronary Angiography; Coronary heart disease; Drug-Eluting Stents; Electrocardiography; Female; Heart; Heart attacks; Humans; Immunosuppressive Agents - administration & dosage; Male; Medical imaging; Medical sciences; Medical treatment; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Pharmacology. Drug treatments; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Sirolimus - administration & dosage; Stents; Thrombosis; Time Factors; Treatment Outcome; Myocardial infarction; Prognosis; Sirolimus; Instrumentation therapy; Cardiovascular disease; Metal; Coronary heart disease; Myocardial disease; ST elevation; Antibiotic; Circulatory system; Immunosuppressive agent; Antibacterial agent; Cardiology; Drug eluting stent; Comparative study
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2010.02.005

To compare the long-term efficacy and safety of sirolimus-eluting stents (SES) to those of bare-metal stents (BMS) for ST-segment elevation myocardial infarction, outcomes were assessed in 310 patients (mean age age 59 ± 11 years, 78% men) included in the randomized MISSION! Intervention Study: A Prospective Randomised Controlled Trial to Evaluate the Efficacy of Drug-Eluting Stents Versus Bare-Metal Stents for the Treatment of Acute Myocardial Infarction after a median follow-up period of 38 months. All patients were treated with aspirin (lifelong) and clopidogrel for 1 year after stent implantation. Except for a significant difference between reference vessel diameters (SES 2.76 mm vs BMS 2.92 mm, p = 0.02), there were no significant differences in baseline and angiographic characteristics between the treatment groups (158 SES, 152 BMS). A significant difference between SES and BMS patients for all revascularization end points was found after the first year of follow-up. However, at 3 years of follow-up, although there was still a trend toward better clinical outcomes in SES-treated patients, differences were no longer significant (death 4.4% vs 6.6%, p = 0.41; target vessel–related myocardial infarction 2.5% vs 4.6%, p = 0.32; target vessel revascularization 8.9% vs 15.8%, p = 0.06), target lesion revascularization 6.3% vs 12.5%, p = 0.06; and target vessel failure 12.0% vs 19.7%, p = 0.06). Three cases of very late (definite) stent thrombosis were observed in the SES group (1.9%) versus none in the BMS group (p = 0.14). In conclusion, the significant SES benefit (compared to BMS) in patients with ST-segment elevation myocardial infarctions at 1-year follow-up in terms of target vessel revascularizations decreased to some extent because of more similar target vessel revascularization rates during the 2 subsequent years. Rates of death and nonfatal recurrent MI remained comparable.