Clinical outcomes of drug-eluting stents vs. Bare-metal stents in acute myocardial infarction patients under dialysis: A nationwide cohort study

Background: Data on the cardiovascular (CV) outcomes of drug-eluting stents (DES) vs. bare-metal stents (BMS) in patients with acute myocardial infarction (AMI) under dialysis are limited. Methods and Results: We analyzed the data from 42,592 AMI patients in the Taiwan National Health Insurance Research Database between 1 January 2007 and 31 December 2011. A total of 984 AMI patients under dialysis were selected as the study cohort. We evaluated the clinical outcomes by comparing 492 subjects who had DES to 492 matched subjects who had BMS. The primary composite outcomes, which included recurrent MI, coronary revascularization and CV death, were significantly lower in the DES group than in the BMS group (41.7% vs. 47.6%, hazard ratio (HR), 0.77; 95% confidence interval (CI), 0.63–0.92, P=0.005) after mean 1.2 years. The patients who received DES had a lower risk of recurrent MI (HR, 0.63; 95% CI, 0.45–0.90), CV death (HR, 0.74; 95% CI, 0.56– 0.98) and all-cause mortality (HR, 0.74; 95% CI, 0.61–0.89) than those who used BMS, but a similar risk of major bleeding (HR, 0.99; 95% CI, 0.69–1.42, P=0.952) and ischemic stroke (HR, 1.15; 95% CI, 0.66–2.01, P=0.631). Conclusions: Among AMI patients on dialysis undergoing percutaneous coronary interventions, DES implantation significantly reduced the risk of recurrent MI, CV death and all-cause mortality compared with BMS implantation.