Drug-eluting stents (DES) are the recommended stents for primary percutaneous coronary intervention (PCI). This study aimed to determine why interventional cardiologists used non-DES and how it influenced patient prognoses. The efficacy and safety outcomes of the different stents were also compared in patients treated with either prasugrel or ticagrelor. Of the PRAGUE-18 study patients, 749 (67.4%) were treated with DES, 296 (26.6%) with bare-metal stents (BMS), and 66 (5.9%) with bioabsorbable vascular scaffold/stents (BVS) between 2013 and 2016. Cardiogenic shock at presentation, left main coronary artery disease, especially as the culprit lesion, and right coronary artery stenosis were the reasons for selecting a BMS. The incidence of the primary composite net-clinical endpoint (EP) (death, nonfatal myocardial infarction, stroke, serious bleeding, or revascularization) at seven days was 2.5% vs. 6.3% and 3.0% in the DES, vs. with BMS and BVS, respectively (HR 2.7; 95% CI 1.419-5.15, p = 0.002 for BMS vs. DES and 1.25 (0.29-5.39) p = 0.76 for BVS vs. DES). Patients with BMS were at higher risk of death at 30 days (HR 2.20; 95% CI 1.01-4.76; for BMS vs. DES, p = 0.045) and at one year (HR 2.1; 95% CI 1.19-3.69; p = 0.01); they also had a higher composite of cardiac death, reinfarction, and stroke (HR 1.66; 95% CI 1.0-2.74; p = 0.047) at one year. BMS were associated with a significantly higher rate of primary EP whether treated with prasugrel or ticagrelor. In conclusion, patients with the highest initial risk profile were preferably treated with BMS over BVS. BMS were associated with a significantly higher rate of cardiovascular events whether treated with prasugrel or ticagrelor.

1st Department of Internal Medicine University Hospital Hradec Kralove 50005 Hradec Kralove Czech Republic

3rd Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Cardiocentre 10034 Prague Czech Republic

Cardiocentre Department of Cardiology Regional Hospital 37001 Ceske Budejovice Czech Republic

Cardiocentre Regional Hospital 36001 Karlovy Vary Czech Republic

Cardiology Centre AGEL 53203 Pardubice Czech Republic

Cardiovascular Center Hospital Podlesi AGEL Research and Training Institute 73961 Trinec Czech Republic

Department of Cardiology University Hospital and Faculty of Medicine Charles University 30599 Pilsen Czech Republic

Department of Internal Medicine and Cardiology Faculty of Medicine of Masaryk University and University Hospital 62500 Brno Czech Republic

Department of Physiology and 2nd Department of Medicine Department of Cardiovascular Medicine 1st Faculty of Medicine Charles University 12808 Prague Czech Republic

Faculty of Medicine Institute of Biostatistics and Analyses Masaryk University 62500 Brno Czech Republic

Faculty of Medicine Suez Canal University Ismailia P O Box 41522 Egypt

ICRC Department of Cardioangiology St Anne University Hospital Masaryk University 65691 Brno Czech Republic

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