Tarunjit SinghDepartment of Internal MedicineWestchester Medical CenterNew York Medical CollegeValhalla NY

To compare Major Adverse Cardiac Events (MACE) in Bare- metal versus drug-eluting stent in patients treated with TNK prior to being admitted to our facility for PCI.

Defined as occurrence of one of the following :

Myocardial Infarction Target Vessel Revascularization Death

Prehospital Fibrinolysis Improvement in survival Smaller infarct size Improved ventricular healing Reduction in the extent of left

ventricular dysfunction Greater electrical stability

GISSI-2 and ISIS-2 – Streptokinase GUSTO-I trial – Alteplase GUSTO III trial compared Reteplase with

Alteplase ASSENT-2 compared Tenecteplase to Alteplase The net effect in major thrombolytic trials has

been an approximately 30 percent reduction in short-term mortality to a value of 7 to 10 percent.

PCI after fibrinolysis There are three settings in which

Percutaneous Coronary Intervention (PCI) is performed after fibrinolysis:

Facilitated PCI, in which a fibrinolytic drug is given prior to planned PCI in an attempt to achieve an open infarct-related artery before arrival in the catheterization laboratory

Rescue / Salvage PCI is defined as PCI performed within 12 hours of failed fibrinolysis (primary failure) in patients with evidence of continuing or recurrent myocardial ischemia

Analysis of 376 consecutive patients ,out of which 102 received BMS and 274 received DES from 2003 to 2005.

The 376 patients were followed for a period of 43± 17 months.

End point of follow-up was occurrence of MACE.

Choice of stent type was at the discretion of the operator.

Chi-square or Fisher’s exact test were done for categorical variables.

Student’s T test were done for continuous variables.

Variable BMS

(n= 102)

DES

(n= 274)

P value

Age (years) 64 ± 12 63 ± 12 ns

Male 73 (72%) 197 (72%) ns

Female 29 (28%) 77 (28%) ns

Smoking 48 (45%) 98 (36%) ns

Hypertension 94 (92%) 263 (96%) ns

Dyslipidemia 99 (97%) 266 (97%) ns

Diabetes mellitus 39 (38%) 118 (43%) ns

BMI ≥ 30 kg/m² 34 (33%) 65 (24%) ns

Variable BMS DES P value

Aspirin use 101 (99%) 271 (99%) ns

Clopidogrel use 102 (100%) 274 (100%) ns

Beta blockers use 90 (88%) 260 (95%) ns

Ace Inhibitor use 45 (44%) 129 (47%) ns

Statin use 99 (97%) 271 (99%) ns

Follow-up (months)

42 ± 19 43 ± 15 ns

Coronary artery bypass grafting

13 (13%) 18 (7%) ns

No of vessel diseased

BMS DES P value

1-vessel disease 53 (52%) 134(49%) Ns

2 vessel disease 22 (22%) 89 (32%) Ns

3 vessel disease 27 (26%) 51 (19%) Ns

Lesion Complexity P value

Type A 34 (33%) 106 (39%) ns

Type B 29 (29%) 95 (34%) ns

Type C 39 (38%) 73 (27%) ns

Stent length (mm) 27 ± 15 25 ± 14 ns

Stent width (mm) 3.2 ± 0.6 3.0 ± 0.3 <.0001

Variable BMS

(n=102)

DES

(n=204)

P value

Myocardial infarction

4 (4%) 8 (3%) ns

TVR 16 (16%) 27 (10%) ns

Death 12 (12%) 14 (5%) 0.024

MACE 25 (25%) 40 (15%) 0.024

Prognostic Factors

Parameter Estimate

Standard Error

P value Hazard Ratio

Prior coronary artery surgery

0.797 0.339 0.019 2.218

Width of stent

-0.816 0.296 0.006 0.442

Bare-metal stent

0.604 0.259 0.019 1.830

Prior CABG surgery, Decreased stent width and the use of bare-metal stents (BMS) were independent risk factors for MACE.

BMS had a 1.8 times higher incidence of developing MACE as compared to DES.

No increased rate of acute or chronic thrombosis

after thrombolysis in either group. The increased rate of MACE in BMS group

may be attributed to increased incidence of restenosis.

THANK YOU