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Selective use of contemporary drug eluting stents in primary angioplasty for ST elevation myocardial infarction. Pooled analysis of COMFORTABLE-AMI and EXAMINATION.

Selective use of contemporary drug eluting stents in primary angioplasty for ST elevation myocardial infarction. Pooled analysis of COMFORTABLE-AMI and EXAMINATION.
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Baumbach A, Heg D, Räber L, Ostoijc M, Brugaletta S, Strange JW, Johnson TW, Juni P, Engstrøm T, Serruys PW, Sabate M, Windecker S,


Baumbach A, Heg D, Räber L, Ostoijc M, Brugaletta S, Strange JW, Johnson TW, Juni P, Engstrøm T, Serruys PW, Sabate M, Windecker S, (click to view)

Baumbach A, Heg D, Räber L, Ostoijc M, Brugaletta S, Strange JW, Johnson TW, Juni P, Engstrøm T, Serruys PW, Sabate M, Windecker S,

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EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 2016 Oct 18() pii EIJ-D-16-00408
Abstract
AIMS
Selective use of DES only in patients at higher risk of MACE is common practice, particularly in health care systems with a large premium payable for DES. We aimed to identify subgroups of patients in which the use of BMS in primary percutaneous coronary intervention (PPCI) for STEMI can still be justified.

METHODS AND RESULTS
We performed a patient-level pooled analysis of COMFORTABLE-AMI and EXAMINATION comparing contemporary DES with BMS in PPCI. A risk score was applied using three parameters: lesion length>15mm, vessel size <3mm, and diabetes mellitus. Individual data were available for 2655 patients. The incidence of MACE at one year was incrementally higher in patients with risk scores of 1 or 2/3. MACE rates were lower in patients with risk score 0 or 1 who were treated with DES (p=0.0073 and p=0.008). No difference in death or reinfarction was seen between DES and BMS in any group. There was a significant reduction in TLR with DES in all three groups. CONCLUSIONS
A score comprising vessel size, lesion length, and diabetes did not identify patients at low risk with equivalent or better results from BMS use. The results suggest that the practice of only selective use of DES in primary PCI should be discouraged.

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