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Selection criteria for drug-eluting versus bare-metal stents and the impact of routine angiographic follow-up: 2-year insights from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial


, : Selection criteria for drug-eluting versus bare-metal stents and the impact of routine angiographic follow-up: 2-year insights from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial. Journal of the American College of Cardiology 56(19): 1597-1604

We sought to identify patients with ST-segment elevation myocardial infarction most likely to benefit from drug-eluting stents (DES), and to evaluate the impact of routine angiographic follow-up on the apparent differences between stent types. DES might have greatest utility in patients who would benefit most from their antirestenotic properties. We randomly assigned 3,006 patients with ST-segment elevation myocardial infarction to paclitaxel-eluting stents (PES) or to bare-metal stents (BMS). Events were assessed at 12 months and 24 months, with a subset undergoing routine angiographic follow-up at 13 months. Using well-known risk factors for restenosis and target lesion revascularization (TLR), risk groups were formed to examine the absolute differences between PES and BMS. Compared with BMS, PES reduced TLR at 12 months from 7.4% to 4.5% (p = 0.003). Insulin-treated diabetes mellitus (hazard ratio: 3.12), reference vessel diameter ≤3.0 mm (hazard ratio: 2.89), and lesion length ≥30 mm (hazard ratio: 2.49) were independent predictors of 12-month TLR after BMS. In patients with 2 or 3 of these baseline risk factors, PES compared with BMS markedly reduced 12-month TLR (19.8% vs. 8.1%, p = 0.003). In patients with 1 of these risk factors, the 12-month rates of TLR were modestly reduced by PES (7.3% vs. 4.3%, p = 0.02). The 12-month TLR rates were low and similar for both stents in patients with 0 risk factors (3.3% vs. 3.2%, p = 0.93). Routine 13-month angiographic follow-up resulted in a marked increase in TLR procedures (more so with BMS) so that the absolute incremental benefit of PES compared with BMS doubled from 2.9% at 12 months to 6.0% at 24 months, a difference evident in all risk strata. Patients at high risk for TLR after BMS in ST-segment elevation myocardial infarction for whom DES are of greatest benefit may be identified. Conversely, DES may be of less clinical benefit for patients at lower risk for TLR after BMS. Routine angiographic follow-up increases the perceived clinical benefits of DES, and must be avoided to accurately estimate absolute treatment effects. (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI]; NCT00433966).

US$19.90

PMID: 20888162

DOI: 10.1016/j.jacc.2010.08.608


Other references

Worland, M.R.; Block, W., 1994: Survival of sub-zero temperatures by South Georgian beetles. Cryo Letters 15(1): 4

Beighton, D.; Hayday, H.; Walker, J., 1985: The relationship between the number of the bacterium Streptococcus mutans at discrete sites on the dentition of macaque monkeys (Macaca fascicularis) and the subsequent development of dental caries. Sixteen consecutively-born monkeys were used in a longitudinal study to determine the changes occurring in the total number of bacteria in the palatal grooves of the upper left first deciduous molar teeth, following the introduction of a sucrose-b...

Palmer Stephanie A.; Van Horn Stephen R.; Farnsworth Katherine L.; Law Eric W., 2004: Assessment of the use of conceptests in promoting peer instruction during lecture. Conceptests were incorporated into two traditional introductory geology classes in an attempt to promote peer instruction during lecture. Conceptests are comprised of questions specifically designed to assess a student's understanding of the...

Bodingbauer, J.; Hager, G., 1959: Aetiology of oligodontia in dogs. A large part of this paper is a criticism of H. Kretzer's dissertation "Pramolarverlust bei Caniden" (Giessen, 1951). The authors concluded that oligodontia was inherited and was not caused after birth by topographical peculiarities...

Mychajlowskij W.; Chan T.H., 1976: The synthesis of alkenes from carbonyl compounds and carbanions alpha to silicon part 5 stereoselective synthesis of e and z di substituted alkenes. Tetrahedron Letters 49: 4439-4442

Almeida, Jão.A.S.; Marques, E.F.; Jurado, Aália.S.; Pais, A.A.C.C., 2011: The effect of cationic gemini surfactants upon lipid membranes. An experimental and molecular dynamics simulation study. Gemini surfactants possess interesting interfacial and aggregation properties that have prompted comprehensive studies and successful applications in a wide variety of fields. However, a systematic study on the effect of gemini tail and spacer len...

Wade, Ba, 1979: Cable logging basics. Northern logger and timber processor 28(6): 10-11

Skempton A.W.; Vaughan P.R., 1993: The failure of Carsington Dam. Geotechnique 43(1): 151-173

Korobova, T.B., 1955: Some data on fertilization in mammals. Oviducts of white mice were fixed 3-70 hours after insemination and the state of the nuclei in sections of 92 ova was studied. No nuclei were observed in the cells during the first 6 hours, then one or two pronuclei appeared, while after 10-12 hou...

Maitani, T., 1979: A comparison of turbulence statistics in the surface layer over plant canopies with those over several other surfaces. Turbulence statistics, including higher order moments, in the surface layer over plant canopies were compared with those observed over several different surfaces, using a nondimensional height (z d)/z0: The values of (z d)/z0extend over a very wid...