Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction:  5 Years Follow-Up From the Randomized DEDICATION Trial (Drug Elution and Distal Protection in Acute Myocardial Infarction)

Lene Holmvang; Henning Kelbæk; Anne Kjer Kaltoft; Leif Thuesen; Jens Flensted Lassen; Peter Clemmensen; Lene Kløvgaard; Thomas Engstrøm; Hans Erik Bøtker; Kari Saunamäki; Lars Romer Krusell; Erik Jørgensen; Hans-Henrik Tilsted; Evald Høj Christiansen; Jan Ravkilde; Lars Køber; Klaus Fuglsang Kofoed; Christian Juhl Terkelsen; Steffen Helqvist

doi:10.1016/j.jcin.2012.12.129

Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: 5 Years Follow-Up From the Randomized DEDICATION Trial (Drug Elution and Distal Protection in Acute Myocardial Infarction)

Lene Holmvang, Henning Kelbæk, Anne Kjer Kaltoft, Leif Thuesen, Jens Flensted Lassen, Peter Clemmensen, Lene Kløvgaard, Thomas Engstrøm, Hans Erik Bøtker, Kari Saunamäki, Lars Romer Krusell, Erik Jørgensen, Hans-Henrik Tilsted, Evald Høj Christiansen, Jan Ravkilde, Lars Køber, Klaus Fuglsang Kofoed, Christian Juhl Terkelsen, Steffen Helqvist

Department of Clinical Medicine

25 Citations (Scopus)

Abstract

Objectives: This study sought to compare the long-term effects of drug-eluting stent (DES) compared with bare-metal stent (BMS) implantation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Background: The randomized DEDICATION (Drug Elution and Distal Protection in Acute Myocardial Infarction) trial evaluated the outcome after DES compared with BMS implantation in patients with STEMI undergoing primary percutaneous coronary intervention. Methods: Patients with a high-grade stenosis/occlusion of a native coronary artery presenting with symptoms <12 h and ST-segment elevation were enrolled after giving informed consent. Patients were randomly assigned to receive a DES or a BMS in the infarct-related lesion. Patients were followed for at least 5 years, and clinical endpoints were evaluated from population registries and hospital charts. The main endpoint was the occurrence of the first major adverse cardiac event (MACE), defined as cardiac death, nonfatal recurrent myocardial infarction, and target lesion revascularization. Results: Complete clinical status was available in 623 patients (99.5%) at 5 years follow-up. The combined MACE rate was insignificantly lower in the DES group (16.9% vs. 23%), mainly driven by a lower need of repeat revascularization (p = 0.07). Whereas the number of deaths from all causes tended to be higher in the DES group (16.3% vs. 12.1%, p = 0.17), cardiac mortality was significantly higher (7.7% vs. 3.2%, p = 0.02). The 5-year stent thrombosis rates were generally low and similar between the DES and the BMS groups. No cardiac deaths occurring within 1 month could be clearly ascribed to stent thrombosis, whereas stent thrombosis was involved in 78% of later-occurring deaths. Conclusions: The 5-year MACE rate was insignificantly different, but the cardiac mortality was higher after DES versus BMS implantation in patients with STEMI. Stent thrombosis was the main cause of late cardiac deaths.

Original language	English
Journal	J A C C: Cardiovascular Interventions
Volume	6
Issue number	6
Pages (from-to)	548-553
Number of pages	6
ISSN	1936-8798
DOIs	https://doi.org/10.1016/j.jcin.2012.12.129
Publication status	Published - Jun 2013

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Holmvang, L., Kelbæk, H., Kaltoft, A. K., Thuesen, L., Lassen, J. F., Clemmensen, P., Kløvgaard, L., Engstrøm, T., Bøtker, H. E., Saunamäki, K., Krusell, L. R., Jørgensen, E., Tilsted, H-H., Christiansen, E. H., Ravkilde, J., Køber, L., Kofoed, K. F., Terkelsen, C. J., & Helqvist, S. (2013). Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: 5 Years Follow-Up From the Randomized DEDICATION Trial (Drug Elution and Distal Protection in Acute Myocardial Infarction). J A C C: Cardiovascular Interventions, 6(6), 548-553. https://doi.org/10.1016/j.jcin.2012.12.129

Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction : 5 Years Follow-Up From the Randomized DEDICATION Trial (Drug Elution and Distal Protection in Acute Myocardial Infarction). / Holmvang, Lene; Kelbæk, Henning; Kaltoft, Anne Kjer et al.

In: J A C C: Cardiovascular Interventions, Vol. 6, No. 6, 06.2013, p. 548-553.

Research output: Contribution to journal › Journal article › Research › peer-review

Holmvang, L, Kelbæk, H, Kaltoft, AK, Thuesen, L, Lassen, JF, Clemmensen, P, Kløvgaard, L, Engstrøm, T, Bøtker, HE, Saunamäki, K, Krusell, LR, Jørgensen, E, Tilsted, H-H, Christiansen, EH, Ravkilde, J, Køber, L , Kofoed, KF, Terkelsen, CJ & Helqvist, S 2013, 'Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: 5 Years Follow-Up From the Randomized DEDICATION Trial (Drug Elution and Distal Protection in Acute Myocardial Infarction)', J A C C: Cardiovascular Interventions, vol. 6, no. 6, pp. 548-553. https://doi.org/10.1016/j.jcin.2012.12.129

Holmvang L, Kelbæk H, Kaltoft AK, Thuesen L, Lassen JF, Clemmensen P et al. Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: 5 Years Follow-Up From the Randomized DEDICATION Trial (Drug Elution and Distal Protection in Acute Myocardial Infarction). J A C C: Cardiovascular Interventions. 2013 Jun;6(6):548-553. doi: 10.1016/j.jcin.2012.12.129

Holmvang, Lene ; Kelbæk, Henning ; Kaltoft, Anne Kjer et al. / Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction : 5 Years Follow-Up From the Randomized DEDICATION Trial (Drug Elution and Distal Protection in Acute Myocardial Infarction). In: J A C C: Cardiovascular Interventions. 2013 ; Vol. 6, No. 6. pp. 548-553.

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title = "Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: 5 Years Follow-Up From the Randomized DEDICATION Trial (Drug Elution and Distal Protection in Acute Myocardial Infarction)",

abstract = "Objectives: This study sought to compare the long-term effects of drug-eluting stent (DES) compared with bare-metal stent (BMS) implantation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Background: The randomized DEDICATION (Drug Elution and Distal Protection in Acute Myocardial Infarction) trial evaluated the outcome after DES compared with BMS implantation in patients with STEMI undergoing primary percutaneous coronary intervention. Methods: Patients with a high-grade stenosis/occlusion of a native coronary artery presenting with symptoms <12 h and ST-segment elevation were enrolled after giving informed consent. Patients were randomly assigned to receive a DES or a BMS in the infarct-related lesion. Patients were followed for at least 5 years, and clinical endpoints were evaluated from population registries and hospital charts. The main endpoint was the occurrence of the first major adverse cardiac event (MACE), defined as cardiac death, nonfatal recurrent myocardial infarction, and target lesion revascularization. Results: Complete clinical status was available in 623 patients (99.5%) at 5 years follow-up. The combined MACE rate was insignificantly lower in the DES group (16.9% vs. 23%), mainly driven by a lower need of repeat revascularization (p = 0.07). Whereas the number of deaths from all causes tended to be higher in the DES group (16.3% vs. 12.1%, p = 0.17), cardiac mortality was significantly higher (7.7% vs. 3.2%, p = 0.02). The 5-year stent thrombosis rates were generally low and similar between the DES and the BMS groups. No cardiac deaths occurring within 1 month could be clearly ascribed to stent thrombosis, whereas stent thrombosis was involved in 78% of later-occurring deaths. Conclusions: The 5-year MACE rate was insignificantly different, but the cardiac mortality was higher after DES versus BMS implantation in patients with STEMI. Stent thrombosis was the main cause of late cardiac deaths.",

author = "Lene Holmvang and Henning Kelb{\ae}k and Kaltoft, {Anne Kjer} and Leif Thuesen and Lassen, {Jens Flensted} and Peter Clemmensen and Lene Kl{\o}vgaard and Thomas Engstr{\o}m and B{\o}tker, {Hans Erik} and Kari Saunam{\"a}ki and Krusell, {Lars Romer} and Erik J{\o}rgensen and Hans-Henrik Tilsted and Christiansen, {Evald H{\o}j} and Jan Ravkilde and Lars K{\o}ber and Kofoed, {Klaus Fuglsang} and Terkelsen, {Christian Juhl} and Steffen Helqvist",

year = "2013",

month = jun,

doi = "10.1016/j.jcin.2012.12.129",

language = "English",

volume = "6",

pages = "548--553",

journal = "J A C C: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier",

number = "6",

}

TY - JOUR

T1 - Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction

T2 - 5 Years Follow-Up From the Randomized DEDICATION Trial (Drug Elution and Distal Protection in Acute Myocardial Infarction)

AU - Holmvang, Lene

AU - Kelbæk, Henning

AU - Kaltoft, Anne Kjer

AU - Thuesen, Leif

AU - Lassen, Jens Flensted

AU - Clemmensen, Peter

AU - Kløvgaard, Lene

AU - Engstrøm, Thomas

AU - Bøtker, Hans Erik

AU - Saunamäki, Kari

AU - Krusell, Lars Romer

AU - Jørgensen, Erik

AU - Tilsted, Hans-Henrik

AU - Christiansen, Evald Høj

AU - Ravkilde, Jan

AU - Køber, Lars

AU - Kofoed, Klaus Fuglsang

AU - Terkelsen, Christian Juhl

AU - Helqvist, Steffen

PY - 2013/6

Y1 - 2013/6

N2 - Objectives: This study sought to compare the long-term effects of drug-eluting stent (DES) compared with bare-metal stent (BMS) implantation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Background: The randomized DEDICATION (Drug Elution and Distal Protection in Acute Myocardial Infarction) trial evaluated the outcome after DES compared with BMS implantation in patients with STEMI undergoing primary percutaneous coronary intervention. Methods: Patients with a high-grade stenosis/occlusion of a native coronary artery presenting with symptoms <12 h and ST-segment elevation were enrolled after giving informed consent. Patients were randomly assigned to receive a DES or a BMS in the infarct-related lesion. Patients were followed for at least 5 years, and clinical endpoints were evaluated from population registries and hospital charts. The main endpoint was the occurrence of the first major adverse cardiac event (MACE), defined as cardiac death, nonfatal recurrent myocardial infarction, and target lesion revascularization. Results: Complete clinical status was available in 623 patients (99.5%) at 5 years follow-up. The combined MACE rate was insignificantly lower in the DES group (16.9% vs. 23%), mainly driven by a lower need of repeat revascularization (p = 0.07). Whereas the number of deaths from all causes tended to be higher in the DES group (16.3% vs. 12.1%, p = 0.17), cardiac mortality was significantly higher (7.7% vs. 3.2%, p = 0.02). The 5-year stent thrombosis rates were generally low and similar between the DES and the BMS groups. No cardiac deaths occurring within 1 month could be clearly ascribed to stent thrombosis, whereas stent thrombosis was involved in 78% of later-occurring deaths. Conclusions: The 5-year MACE rate was insignificantly different, but the cardiac mortality was higher after DES versus BMS implantation in patients with STEMI. Stent thrombosis was the main cause of late cardiac deaths.

AB - Objectives: This study sought to compare the long-term effects of drug-eluting stent (DES) compared with bare-metal stent (BMS) implantation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Background: The randomized DEDICATION (Drug Elution and Distal Protection in Acute Myocardial Infarction) trial evaluated the outcome after DES compared with BMS implantation in patients with STEMI undergoing primary percutaneous coronary intervention. Methods: Patients with a high-grade stenosis/occlusion of a native coronary artery presenting with symptoms <12 h and ST-segment elevation were enrolled after giving informed consent. Patients were randomly assigned to receive a DES or a BMS in the infarct-related lesion. Patients were followed for at least 5 years, and clinical endpoints were evaluated from population registries and hospital charts. The main endpoint was the occurrence of the first major adverse cardiac event (MACE), defined as cardiac death, nonfatal recurrent myocardial infarction, and target lesion revascularization. Results: Complete clinical status was available in 623 patients (99.5%) at 5 years follow-up. The combined MACE rate was insignificantly lower in the DES group (16.9% vs. 23%), mainly driven by a lower need of repeat revascularization (p = 0.07). Whereas the number of deaths from all causes tended to be higher in the DES group (16.3% vs. 12.1%, p = 0.17), cardiac mortality was significantly higher (7.7% vs. 3.2%, p = 0.02). The 5-year stent thrombosis rates were generally low and similar between the DES and the BMS groups. No cardiac deaths occurring within 1 month could be clearly ascribed to stent thrombosis, whereas stent thrombosis was involved in 78% of later-occurring deaths. Conclusions: The 5-year MACE rate was insignificantly different, but the cardiac mortality was higher after DES versus BMS implantation in patients with STEMI. Stent thrombosis was the main cause of late cardiac deaths.

U2 - 10.1016/j.jcin.2012.12.129

DO - 10.1016/j.jcin.2012.12.129

M3 - Journal article

C2 - 23683734

SN - 1936-8798

VL - 6

SP - 548

EP - 553

JO - J A C C: Cardiovascular Interventions

JF - J A C C: Cardiovascular Interventions

IS - 6

ER -