Similar outcomes with BMS and DES in myocardial infarction with cardiogenic shock
medwireNews: Study results suggest that patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) have similar outcomes when treated with drug-eluting stents (DES) or bare metal stents (BMS).
“It remains questionable if the superiority of DES gained in other settings such as stable coronary artery disease or acute coronary syndrome can be simply transferred to AMI complicated by CS,” write the researchers in Heart.
The team conducted a retrospective analysis of data from the IABP-SHOCK II trial, and found that “a substantial” 58% of 652 patients with AMI and CS were treated with BMS, whereas 42% received DES.
The unadjusted incidence of the primary endpoint – a composite of mortality and recurrent AMI within 12 months – was higher among patients receiving BMS compared with DES, with rates of approximately 60% and 40%, respectively.
However, there was no significant difference in the incidence of the composite endpoint between the two groups after adjustment for baseline risk factors, report Georg Fuernau (University Heart Center Lübeck, Germany) and fellow researchers.
There was also no significant difference in 1-year rates of nonfatal AMI between patients receiving BMS and those receiving DES, at 7.0% versus 5.1%.
The authors observed similar rates of most hospital complications occurring within 30 days of admission in the two groups, but patients with DES had a higher rate of ventricular assist device implantation and a lower rate of stent thrombosis than those with BMS (9.4 vs 5.1% and 0.0 vs 1.6%, respectively).
Fuernau and team say that these findings provide support for the safety profile of DES in patients with CS, “with no increase in acute or subacute stent thrombosis,” but note that that the high proportion of patients with BMS implantation during the 2009–2012 study period was “not surprising” in light of evidence suggesting an increased risk for very late thrombosis with first-generation DES.
“[R]esults of randomised second-generation DES trials in the setting of AMI were not available at the time of patient enrollment in the present trial,” they add.
Whilst the authors caution that the validity of their findings “still needs to be proven in a prospective randomised trial,” they believe the results suggest that DES use is “at least equal to BMS in AMI complicated by CS.”
And they conclude that future studies should “clarify if DES have the potential to improve the outcome in patients with AMI complicated by CS, at least in survivors of the hospital period.”
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