Long-term persisting stent after heart attack

This study evaluated the effects of the sirolimus-eluting stents (SES) compared to bare-metal stents (BMS) on the 5-year clinical outcomes of patients with acute myocardial infarction.

Acute myocardial infarction or AMI (heart attack) happens when blood stops flowing properly to part of the heart and the heart muscle (myocardium) is injured due lack of oxygen. The most common cause of AMI is atherosclerosis (narrowing of the arteries due to accumulation of fat in the wall of the arteries) which leads to coronary artery disease (CAD). SES is a tube placed in the coronary artery that slowly releases sirolimus (a drug that prevents rejection of the stent and overgrowth of normal tissue) to keep the arteries open, used for the treatment of CAD. In comparison with BMS (a mesh-like tube of thin wire), SES has been shown to reduce target lesion revascularization or TLR (any repeated intervention on the same place of a blood vessel). This study aimed to evaluate whether this effect persists over a period of 5 years after an AMI.

This study included 310 patients with AMI. Patients were randomly assigned to receive either SES (155 patients) or BMS (155 patients). The main parameter evaluated was the need for another intervention (target vessel failure or TVF) during 5 years of follow up. Also, patients were followed up for major cardiovascular events or MACE (recurrent AMI or death), and stent thrombosis (blood clots inside the stent).

Results showed that SES was associated with a higher reduction in TVF at 5 years compared with BMS (85% versus 76%). Also, patients receiving SES had a significant TLR reduction compared to patients in the BMS group (92% versus 85%). No significant differences were seen concerning MACE between the two groups after 5 years. The greatest benefit was seen in the first year of follow-up, which was maintained at 5 years. Moreover, TLR within one year was associated with a 3.4 times higher risk of recurrent AMI or death.

In conclusion, this study showed that SES is safe and is associated with a significant reduction in TVF and TLR compared to BMS at 5 years follow-up in patients with AMI.

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