Evolução tardia de pacientes com infarto agudo do miocárdio tratados com stents farmacológicos na prática diária do mundo real: subanálise do Registro DESIRE (Drug-Eluting Stent In the REal World)

BACKGROUND: Previous studies comparing drug-eluting stents (DES) and bare-metal stents suggest efficacy and safety of the DES in the treatment of patients with myocardial infarction (MI). However, the late evolution of patients with MI treated with DES in the daily practice remains unknown. Our goal was to investigate the late follow-up of patients with MI recently treated with DES in the real world. METHODS: Between May 2002 and June 2009, 3,018 non-selected patients with indication for elective or urgent percutaneous coronary intervention have been consecutively treated with DES in a clinical institution. The 7-year follow-up was performed in 98% of these patients, with a median of 3.4 years. The patients were divided in two groups: patients with recent MI ( 99%) was similar between groups. In the late follow-up, the incidence of cardiac death (6.4% vs. 2.7%; P < 0.001) and stent thrombosis (3.6% vs. 1.3%; P < 0.001) was significantly greater in the recent MI group. Recent MI remained an independent predictor of stent thrombosis in multivariate analysis (HR 2.96, 95% CI 1.62-5.41; P < 0,001). CONCLUSIONS: Patients with MI < 30 days treated with DES had a worse prognosis when compared with patients without recent MI, including a higher incidence of cardiac death and a 2.5 times greater occurrence of stent thrombosis rate up to 7-year follow-up.