Meta-analysis of randomized trials on drug-eluting stents vs. bare-metal stents in patients with acute myocardial infarction

• Published in: European heart journal 2007-11, Vol.28 (22), p.2706-2713
• Main Authors: Kastrati, Adnan, Dibra, Alban, Spaulding, Christian, Laarman, Gerrit J., Menichelli, Maurizio, Valgimigli, Marco, Di Lorenzo, Emilio, Kaiser, Christoph, Tierala, Ilkka, Mehilli, Julinda, Seyfarth, Melchior, Varenne, Olivier, Dirksen, Maurits T., Percoco, Gianfranco, Varricchio, Attilio, Pittl, Undine, Syvänne, Mikko, Suttorp, Maarten J., Violini, Roberto, Schömig, Albert
• Format: Article
• Language: English
• Subjects: Acute myocardial infarction; Angioplasty, Balloon, Coronary - methods; Angioplasty, Balloon, Coronary - mortality; Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Coronary Restenosis - mortality; Coronary Restenosis - prevention & control; Diseases of the cardiovascular system; Drug-Eluting Stents; Heart; Humans; Medical sciences; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Primary angioplasty; Proportional Hazards Models; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Randomized Controlled Trials as Topic; Restenosis; Stents; Survival Analysis; Thrombosis; Treatment Outcome
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehm402

Aims To compare the efficacy and safety of drug-eluting stents vs. bare-metal stents in patients with acute ST-segment elevation myocardial infarction. Methods and results We performed a meta-analysis of eight randomized trials comparing drug-eluting stents (sirolimus-eluting or paclitaxel-eluting stents) with bare-metal stents in 2786 patients with acute ST-segment elevation myocardial infarction. All patients were followed up for a mean of 12.0–24.2 months. Individual data were available for seven trials with 2476 patients. The primary efficacy endpoint was the need for reintervention (target lesion revascularization). The primary safety endpoint was stent thrombosis. Other outcomes of interest were death and recurrent myocardial infarction. Drug-eluting stents significantly reduced the risk of reintervention, hazard ratio of 0.38 (95% CI, 0.29–0.50), P < 0.001. The overall risk of stent thrombosis: hazard ratio of 0.80 (95% CI, 0.46–1.39), P = 0.43; death: hazard ratio of 0.76 (95% CI, 0.53–1.10), P = 0.14; and recurrent myocardial infarction: hazard ratio of 0.72 (95% CI, 0.48–1.08, P = 0.11) was not significantly different for patients receiving drug-eluting stents vs. bare-metal stents. Conclusion The use of drug-eluting stents in patients with acute ST-segment elevation myocardial infarction is safe and improves clinical outcomes by reducing the risk of reintervention compared with bare-metal stents.