[TCT2007]MIDAS: DES Significantly Reduced All-Cause and Cardiovascular Mortality

Two-year data demonstrate benefits of DES in patients with STEMI & non-ST elevation MI.

Observational results from the New Jersey MIDAS registry were presented for the first time at TCT 2007.

“In the MIDAS database for 2003- 2004, the use of DES in the setting of acute MI was associated with significant reductions of 2-year, all-cause death and cardiovascular mortality when compared with the use of baremetal stents,” said Tudor D. Vagaonescu,MD, PhD.

Researchers from Robert Wood Johnson Medical School in New Brunswick, NJ, where Vagaonescu is
an assistant professor of cardiology in the Department of Cardiovascular Diseases and Hypertension, compared mortality in patients with MI who underwent PCI with placement of a single DES (n = 5,719) or baremetal stent (n = 5,399).

At 2 years, overall survival was 90.2% in DES patients and 85.2% in bare-metal stent patients (P , .0001). And overall survival free from cardiovascular death was 96.2% in DES patients and 92.3% with bare-metal stents (P , .0001) over the same time period.

Patient characteristics were generally similar at baseline. Of note, 54.4% of patients treated with baremetal stents had STEMI, as did 38.8% of DES-treated patients.

Non-STEMI was reported more among DES-treated patients (55.7%) compared with bare-metal stent-treated patients (40.7%).

When the researchers compared DES and bare-metal stents to determine overall survival free from
cardiovascular death in patients with non-STEMI, DES-treated patients fared better; 96.2% for DES vs. 92.3% for bare-metal stents (HR 0.54; P , .0001). Overall survival was 90.2% for DES and 85.2% for baremetal stents in non-ST-elevation MI (HR 0.70; P , .0001).

In-hospital complications including acute MI, arrhythmia, and leftventricular dysfunction and arrhythmia
combinedwere higher with bare-metal stents, while left-ventricular dysfunction alone was similar
between the stents.

“The use of DES, despite decreasing the rates of TLR and TVR when compared with bare-metal stents, is considered controversial in acute MI due to late-stent thrombosis,”said Vagaonescu.

One strength of this analysis is that it is a population-based study of more than 11,000 single-stent PCIs,
Vagaonescu said. He mentioned several other strengths, including complete 2-year follow-up on all patients and all PCIs regardless of success or failure of revascularization.

However, there are several limitations. For one, it was an observational study that used administrative
data. Vagaonescu said there may be unmeasured confounding factors that contribute to the present findings, such as unknown baseline differences, medical management, and differences in duration of dual antiplatelet therapy.