March 21, 2020
Italian AMARCORD Registry Studies Bare-Metal Stent Use in the Current PCI Era
March 21, 2020—Findings from the multicenter, observational AMARCORD study were published by Francesco Giannini, MD, et al in Catheterization & Cardiovascular Interventions. AMARCORD is an Italian multicenter registry of bare-metal stent (BMS) use in the modern percutaneous coronary intervention (PCI) era, focusing on indications for use and clinical outcomes.
This large, contemporary, real‐world, multicenter registry demonstrated that BMS use progressively reduced in the last 5 years. The main reasons for BMS implantation were ST‐segment elevation myocardial infarction (STEMI), advanced age, and physician’s perception of high bleeding risk. High rates of mortality and major adverse cardiac events (MACE) were observed in this real‐world, high‐risk population, concluded the investigators.
As summarized in Catheterization & Cardiovascular Interventions, the registry included all patients who underwent PCI with at least one BMS implantation in 18 Italian centers from January 1, 2013 to December 31, 2017. Rates of BMS use and reasons for BMS implantations were reported for the overall study period and for each year.
Primary outcomes were mortality, bleeding (Bleeding Academic Research Consortium [BARC] and Thrombolysis in Myocardial Infarction [TIMI] non–coronary artery bypass graft [non-CABG] definitions), and MACE (defined as the composite of all‐cause and cardiac death, any MI, target vessel revascularization, or any stent thrombosis).
Among 58,879 patients who underwent PCI in the study period, 2,117 (3.6%) patients (mean age, 73 years; 69.7% male; 73.3% with acute coronary syndrome) were treated with BMS implantation (2,353 treated lesions).
The investigators found that the rate of BMS implantation progressively decreased from 10.1% (2013) to 0.3% (2017). The main reasons for BMS implantation were STEMI (23.1%), advanced age (24.4%), and physician’s perception of high bleeding risk (34%). At a mean follow‐up of 2.2 ± 1.5 years, all‐cause and cardiac mortality were 25.6% and 12.7% (respectively), MACE rate was 35.3%, and any bleeding rate was 13% (BARC 3–5 bleeding, 6.3%; TIMI non‐CABG major bleeding, 6.1%), reported the investigators in Catheterization & Cardiovascular Interventions.