As a treatment for acute MI, PCI with a drug-eluting stent rather than with a bare-metal stent reduces two-year mortality, according to a study.

As a treatment for acute MI, percutaneous coronary intervention (PCI) with a drug-eluting stent rather than with a bare-metal stent reduces two-year mortality and the need for repeat revascularization, according to a report in The New England Journal of Medicine for September 25.

The results are based on a study of all adults who underwent PCI with stenting for acute MI from April 2003 to September 2004 at any acute care, nonfederal hospital in Massachusetts. A total of 4016 patients treated with drug-eluting stents and 3201 with bare-metal stents were included in the final analysis.

In the overall analysis, mortality in drug-eluting stent patients was 10.7 per cent, significantly lower than the 12.8 per cent rate seen in bare metal stent patients (p = 0.02), Dr. Laura Mauri, from Brigham and Women's Hospital in Boston, and colleagues report.

Similarly, the authors found that drug-eluting stents were superior to bare metal stents on subanalyses of MIs with and without ST-segment elevation. In the former case, drug-eluting stents and bare metal stents were tied to mortality rates of 8.5 per cent and 11.6 per cent (p = 0.008), respectively, while in the latter, the corresponding rates were 12.8 per cent and 15.6 per cent (p = 0.04).

Use of drug-eluting stents also reduced the need for repeat revascularization in all patients. These stents also helped prevent recurrent MI, but only in patients without ST-segment elevation MI.

The results support the use of drug-eluting stents over bare metal stents in this patient population, the authors conclude. However, they add that "large, randomized trials with long-term follow-up" are needed to confirm the findings.

N Engl J Med 2008;359:1330-1342