BMS vs DES for primary angioplasty

BMS vs DES for primary angioplasty

BMS vs DES for primary angioplasty: PCI is known to be definitely superior to thrombolysis. Primary angioplasty with stents decreases target vessel revascularization vs primary angioplasty without stents, though difference in mortality may not be significant. GRACE registry suggested that BMS was better than DES in acute MI situation [1]. But recent data with sirolimus eluting stents show promise. TYPHOON trial is one among them [2]. Target vessel failure was reduced. Stent thrombosis was similar. Restenosis was lesser. PASSON trial with paclitaxel eluting stent showed a 4% reduction, but this was not statistically significant. A recent meta analysis showed a trend towards better results with DES. Four year follow of TYPHOON (though only about 70% follow up rates were obtained) showed that the benefits of sirolimus eluting stents was maintained at 4 years. HORIZONS AMI follow up data at 2 years also showed similar results, with comparable stent thrombosis rates and no safety concerns. PASEO trial also showed favourable results, though it is a smaller study, albeit with higher risk patients. A 2009 meta analysis shows a 56% improvement with DES.

References

1. K A A Fox, K A Eagle, J M Gore, Ph G Steg, F A Anderson, GRACE and GRACE2 Investigators. The Global Registry of Acute Coronary Events, 1999 to 2009–GRACE. Heart. 2010 Jul;96(14):1095-101.
2. Christian Spaulding, Emmanuel Teiger, Philippe Commeau, Olivier Varenne, Ezio Bramucci, Michel Slama, Keavin Beatt, Ashok Tirouvanziam, Lech Polonski, Pieter R Stella, Richard Clugston, Jean Fajadet, Xavier de Boisgelin, Christophe Bode, Didier Carrié, Andrejs Erglis, Bela Merkely, Stefan Hosten, Ana Cebrian, Patrick Wang, Hans-Peter Stoll, Patrick Henry. Four-year follow-up of TYPHOON (trial to assess the use of the CYPHer sirolimus-eluting coronary stent in acute myocardial infarction treated with BallOON angioplasty). JACC Cardiovasc Interv. 2011 Jan;4(1):14-23.