TY - JOUR
T1 - Drug-eluting vs bare-metal stents in primary angioplasty
T2 - A pooled patient-level meta-analysis of randomized trials
AU - De Luca, Giuseppe
AU - Dirksen, Maurits T.
AU - Spaulding, Christian
AU - Kelbæk, Henning
AU - Schalij, Martin
AU - Thuesen, Leif
AU - Van Der Hoeven, Bas
AU - Vink, Marteen A.
AU - Kaiser, Christoph
AU - Musto, Carmine
AU - Chechi, Tania
AU - Spaziani, Gaia
AU - Díaz De La Llera, Luis Salvador
AU - Pasceri, Vincenzo
AU - Di Lorenzo, Emilio
AU - Violini, Roberto
AU - Cortese, Giuliana
AU - Suryapranata, Harry
AU - Stone, Gregg W.
PY - 2012/4/23
Y1 - 2012/4/23
N2 - Background: Concerns have emerged regarding a higher risk of stent thrombosis after drug-eluting stent (DES) implantation, especially in the setting of ST-segment elevation myocardial infarction (STEMI). Our objective was to perform a meta-analysis using individual patient data to evaluate the long-term safety and effectiveness of DES compared with bare-metal stents (BMS) in patients undergoing primary percutaneous coronary intervention for STEMI. Data Sources: Formal searches of electronic databases (MEDLINE and CENTRAL) and scientific session presentations from January 2000 to June 2011. Study Selection: We examined all completed randomized trials of DES for STEMI. Data Extraction: Individual patient data. Data Synthesis: Individual patient data were obtained from 11 of 13 trials identified, including a total of 6298 patients (3980 [63.2%] randomized to DES [99% sirolimus-eluting or paclitaxel-eluting stents] and 2318[36.8%] randomized to BMS). At long-term follow-up (mean [SD], 1201 [440] days), DES implantation significantly reduced the occurrence of target-vessel revascularization (12.7% vs 20.1%; hazard ratio [95% CI], 0.57 [0.50-0.66]; P < .001, P value for heterogeneity, .20), without any significant difference in terms of mortality, reinfarction, and stent thrombosis. However, DES implantation was associated with an increased risk of very late stent thrombosis and reinfarction. Conclusions: The present pooled patient-level metaanalysis demonstrates that among patients with STEMI undergoing primary percutaneous coronary intervention, sirolimus-eluting and paclitaxel-eluting stents compared with BMS are associated with a significant reduction in target-vessel revascularization at long-term follow-up. Although there were no differences in cumulative mortality, reinfarction, or stent thrombosis, the incidence of very late reinfarction and stent thrombosis was increased with these DES.
AB - Background: Concerns have emerged regarding a higher risk of stent thrombosis after drug-eluting stent (DES) implantation, especially in the setting of ST-segment elevation myocardial infarction (STEMI). Our objective was to perform a meta-analysis using individual patient data to evaluate the long-term safety and effectiveness of DES compared with bare-metal stents (BMS) in patients undergoing primary percutaneous coronary intervention for STEMI. Data Sources: Formal searches of electronic databases (MEDLINE and CENTRAL) and scientific session presentations from January 2000 to June 2011. Study Selection: We examined all completed randomized trials of DES for STEMI. Data Extraction: Individual patient data. Data Synthesis: Individual patient data were obtained from 11 of 13 trials identified, including a total of 6298 patients (3980 [63.2%] randomized to DES [99% sirolimus-eluting or paclitaxel-eluting stents] and 2318[36.8%] randomized to BMS). At long-term follow-up (mean [SD], 1201 [440] days), DES implantation significantly reduced the occurrence of target-vessel revascularization (12.7% vs 20.1%; hazard ratio [95% CI], 0.57 [0.50-0.66]; P < .001, P value for heterogeneity, .20), without any significant difference in terms of mortality, reinfarction, and stent thrombosis. However, DES implantation was associated with an increased risk of very late stent thrombosis and reinfarction. Conclusions: The present pooled patient-level metaanalysis demonstrates that among patients with STEMI undergoing primary percutaneous coronary intervention, sirolimus-eluting and paclitaxel-eluting stents compared with BMS are associated with a significant reduction in target-vessel revascularization at long-term follow-up. Although there were no differences in cumulative mortality, reinfarction, or stent thrombosis, the incidence of very late reinfarction and stent thrombosis was increased with these DES.
UR - http://www.scopus.com/inward/record.url?scp=84860372502&partnerID=8YFLogxK
U2 - 10.1001/archinternmed.2012.758
DO - 10.1001/archinternmed.2012.758
M3 - Review article
SN - 0003-9926
VL - 172
SP - 611
EP - 621
JO - Archives of Internal Medicine
JF - Archives of Internal Medicine
IS - 8
ER -