Stent better than balloon angioplasty alone after MI

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Compared to balloon angioplasty alone, use of stents in reperfusion therapy in patients after acute myocardial infarction (MI) is associated with improved in-hospital outcomes, researchers report.

The results suggest "that all patients who present with an acute heart attack should receive a stent rather than balloon angioplasty alone," senior investigator Dr. David L. Brown told Reuters Health. "Treatment with a stent reduced the risk of dying in the hospital by 50%."

In the April 1st issue of the American Journal of Cardiology, Dr. Brown and colleagues at the State University of New York-Stony Brook School of Medicine note that although clinical trials have shown the superiority of the stent approach, it's not known whether this holds good in community-based practice.

To investigate, the researchers retrospectively examined data on more than 6000 patients in New York State who, between 1998 and 1999, presented within 23 hours of acute MI and underwent percutaneous coronary intervention. During this time period, drug-eluting stents were not in use.

Stents were placed in 87% of patients. Those who received stents were younger (61 versus 62 years) and were more likely to be male (33% versus 29%). They were all less likely to have had a history of hypertension and diabetes and to have a creatinine level of 2.5 mg/dl or beyond (0.8% versus 2.0%).

Stent use was associated with a significant reduction length of stay (5.9 versus 8.1 days), major cardiovascular events (4.1% versus 12%) and in-hospital mortality (3.5% versus 9.3%).

After adjustment, stent use was associated with a 50% decrease in the risk of in-hospital mortality compared to balloon angioplasty alone. The researchers note that although drug-eluting stents were not studied, this should not have affected these short-term findings.

"The major benefit of drug-eluting stents," they point out, "is the decrease in restenosis months after implantation."