Long-term follow-up of a randomized study of primary stenting versus angioplasty in acute myocardial infarction

PURPOSE: Primary stenting leads to better short-term outcomes than does balloon angioplasty among patients with acute myocardial infarction, but there are no data available on long-term follow-up. SUBJECTS AND METHODS: We designed a randomized study with long-term follow-up to compare primary angioplasty with angioplasty accompanied by implantation of a silicon carbide-coated stent in patients within 24 hours after the onset of acute myocardial infarction. All 88 patients had lesions that were suitable for coronary stenting. RESULTS: There were 44 patients in each of the randomization groups. During long-term follow-up (mean +/- SD: 710+/-282 days), primary stenting was associated with a reduction in the combined endpoint of death, reinfarction, or target vessel revascularization (10 [23%] versus 19 [43%], P = 0.03); death (4 [9%] versus 8 [18%], P = 0.18); reinfarction (1 [2%] versus 4 [9%], P = 0.18); and target lesion revascularization (7 [16%] versus 15 [34%], P = 0.04). Rehospitalization due to ischemic events (unstable angina or reinfarction) was also less frequent in the stent group (6 [14%] versus 10 [23%], P = 0.20). CONCLUSION: Primary stenting in acute myocardial infarction is significantly superior to angioplasty alone in both short-term and long-term follow-up.