Long-term outcome of acute myocardial infarction patients treated with stents versus balloon angioplasty: Results from randomized trials

Aim: To examine the impact of primary stent implantation versus balloon angioplasty on long-term outcome (median 8 years) in 117 patients with ST-elevation myocardial infarction (STEMI) from randomized trials. Methods: Enrolled patients were those presenting with STEMI within 12 h of symptom onset. Patients were randomized to either Palmaz-Schatz stent implantation (N=25) or balloon angioplasty (N=23) between January and November 1996; or Palmaz-Schatz (N=26), or Cordis coil stent implantation (N=24) or balloon angioplasty (N=19) between February 1998 and March 1999. Results: Patients (67 +/- 11 years) arrived to the hospital within median 2.5 h of symptom onset with Killip 1/2/3/4 grade (72/19/7/2%, respectively). The culprit lesion was located in the left anterior descending (50%), right (39%), or left circumflex coronary artery (11%) with TIMI 0/1/2/3 flow (81/5/12/2%, respectively). Clinical/angiographic features were comparable between the 2 groups. During follow-up, there was a significant reduction in cardiac mortality in the stent group (5%) compared to the angioplasty group (17%, log-rank test p=0.04). In addition, the stent group had a lower target lesion revascularization rate (28% versus 52%, p=0.008), and a significantly lower major adverse cardiac event rate (37% versus 67%, p=0.005), than the angioplasty group. Conclusion: Compared to balloon angioplasty, primary stenting resulted in a sustained beneficial effect on cardiac mortality at 8 years. (C) 2008 Elsevier Ireland Ltd. All rights reserved.