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

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 an...

Descripción completa

Detalles Bibliográficos
Autores: 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
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2019
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p2457
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=2457
Access Level:acceso abierto
Palabra clave:bare metal stent
coronary vessels
drug eluting stent
myocardial infarction
percutaneous coronary intervention
id ES_7ca07dd7a1d892b5aac03b323b705de4
oai_identifier_str oai:iibsantpau.fundanetsuite.com:p2457
network_acronym_str ES
network_name_str España
repository_id_str
spelling Does Large Vessel Size Justify Use of Bare-Metal Stents in Primary Percutaneous Coronary Intervention? Insights From the EXAMINATION TrialCosta, FBrugaletta, SPernigotti, AFlores-Ulmanzor, EOrtega-Paz, LCequier, AIniguez, ASerra, AJimenez-Quevedo, PMainar, VCampo, GTespili, Mden Heijer, PBethencourt, AVazquez, Nvan Es, GABackx, BValgimigli, MSerruys, PSabate, Mbare metal stentcoronary vesselsdrug eluting stentmyocardial infarctionpercutaneous coronary interventionBackground: 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.LIPPINCOTT WILLIAMS & WILKINS2019info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=2457Circulation-Cardiovascular InterventionsISSN: 19417640ISSNe: 19417632reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p24572026-06-14T12:41:47Z
dc.title.none.fl_str_mv Does Large Vessel Size Justify Use of Bare-Metal Stents in Primary Percutaneous Coronary Intervention? Insights From the EXAMINATION Trial
title Does Large Vessel Size Justify Use of Bare-Metal Stents in Primary Percutaneous Coronary Intervention? Insights From the EXAMINATION Trial
spellingShingle Does Large Vessel Size Justify Use of Bare-Metal Stents in Primary Percutaneous Coronary Intervention? Insights From the EXAMINATION Trial
Costa, F
bare metal stent
coronary vessels
drug eluting stent
myocardial infarction
percutaneous coronary intervention
title_short Does Large Vessel Size Justify Use of Bare-Metal Stents in Primary Percutaneous Coronary Intervention? Insights From the EXAMINATION Trial
title_full Does Large Vessel Size Justify Use of Bare-Metal Stents in Primary Percutaneous Coronary Intervention? Insights From the EXAMINATION Trial
title_fullStr Does Large Vessel Size Justify Use of Bare-Metal Stents in Primary Percutaneous Coronary Intervention? Insights From the EXAMINATION Trial
title_full_unstemmed Does Large Vessel Size Justify Use of Bare-Metal Stents in Primary Percutaneous Coronary Intervention? Insights From the EXAMINATION Trial
title_sort Does Large Vessel Size Justify Use of Bare-Metal Stents in Primary Percutaneous Coronary Intervention? Insights From the EXAMINATION Trial
dc.creator.none.fl_str_mv 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
author Costa, F
author_facet 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
author_role author
author2 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
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv bare metal stent
coronary vessels
drug eluting stent
myocardial infarction
percutaneous coronary intervention
topic bare metal stent
coronary vessels
drug eluting stent
myocardial infarction
percutaneous coronary intervention
description 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.
publishDate 2019
dc.date.none.fl_str_mv 2019
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=2457
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=2457
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv LIPPINCOTT WILLIAMS & WILKINS
publisher.none.fl_str_mv LIPPINCOTT WILLIAMS & WILKINS
dc.source.none.fl_str_mv Circulation-Cardiovascular Interventions
ISSN: 19417640
ISSNe: 19417632
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869411604748042240
score 15,812429

Similares en LA Referencia