Publication details

Stent Selection for Primary Angioplasty and Outcomes in the Era of Potent Antiplatelets. Data from the Multicenter Randomized Prague-18 Trial

Authors

HLINOMAZ Ota MOTOVSKA Zuzana KNOT Jiri MIKLÍK Roman SABBAH Mulham HROMADKA Milan VARVAROVSKY Ivo DUSEK Jaroslav SVOBODA Michal TOUSEK Frantisek MAJTAN Bohumil SIMEK Stanislav BRANNY Marian JARKOVSKÝ Jiří

Year of publication 2021
Type Article in Periodical
Magazine / Source Journal of Clinical Medicine
MU Faculty or unit

Faculty of Medicine

Citation
Web https://www.mdpi.com/2077-0383/10/21/5103
Doi http://dx.doi.org/10.3390/jcm10215103
Keywords acute myocardial infarction; primary angioplasty; drug-eluting stent; bare-metal stent; bioresorbable scaffolds; ticagrelor; prasugrel
Description Drug-eluting stents (DES) are the recommended stents for primary percutaneous coronary intervention (PCI). This study aimed to determine why interventional cardiologists used non-DES and how it influenced patient prognoses. The efficacy and safety outcomes of the different stents were also compared in patients treated with either prasugrel or ticagrelor. Of the PRAGUE-18 study patients, 749 (67.4%) were treated with DES, 296 (26.6%) with bare-metal stents (BMS), and 66 (5.9%) with bioabsorbable vascular scaffold/stents (BVS) between 2013 and 2016. Cardiogenic shock at presentation, left main coronary artery disease, especially as the culprit lesion, and right coronary artery stenosis were the reasons for selecting a BMS. The incidence of the primary composite net-clinical endpoint (EP) (death, nonfatal myocardial infarction, stroke, serious bleeding, or revascularization) at seven days was 2.5% vs. 6.3% and 3.0% in the DES, vs. with BMS and BVS, respectively (HR 2.7; 95% CI 1.419-5.15, p = 0.002 for BMS vs. DES and 1.25 (0.29-5.39) p = 0.76 for BVS vs. DES). Patients with BMS were at higher risk of death at 30 days (HR 2.20; 95% CI 1.01-4.76; for BMS vs. DES, p = 0.045) and at one year (HR 2.1; 95% CI 1.19-3.69; p = 0.01); they also had a higher composite of cardiac death, reinfarction, and stroke (HR 1.66; 95% CI 1.0-2.74; p = 0.047) at one year. BMS were associated with a significantly higher rate of primary EP whether treated with prasugrel or ticagrelor. In conclusion, patients with the highest initial risk profile were preferably treated with BMS over BVS. BMS were associated with a significantly higher rate of cardiovascular events whether treated with prasugrel or ticagrelor.

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