Meta-analysis of clinical trials on use of drug-eluting stents for treatment of acute myocardial infarction

Background: Recent trials have shown the effects of drug-eluting stents (DES) in treatment of acute myocardial infarction (AMI), but data on the clinical outcome are still incomplete. Methods: We performed a meta-analysis of all trials comparing DES and bare-metal stents (BMS) in AMI. Results: We found 7 randomized trials comparing the effects of DES and BMS in AMI, enrolling a total of 2357 patients (1177 with DES and 1180 with BMS) with a follow-up of 8 to 12 months. Incidence of major cardiac events (death, myocardial infarction, or revascularization) was 9.3% in patients treated with DES and 17.6% in patients with BMS, with a relative risk (RR) of 0.53 with 95% CI 0.43 to 0.66. Incidence of death or myocardial infarction was similar in the two groups, occurring in 5.8% of patients with DES and 6.9% of patients treated with BMS, with an RR of 0.84 (95% CI 0.62-1.15). Target lesion revascularization occurred in 4.8% of DES and in 12.0% of BMS patients, with an RR of 0.40 (95% CI 0.30-0.54). Stent thrombosis occurred in 2.3% in DES versus 2.6% in BMS patients, with an RR of 0.87 (95% CI 0.53-1.45). There was no heterogeneity among trials in any of the analyses (I² = 0% for all). Conclusions: Drug-eluting stents significantly reduce need for revascularization in patients with AMI, without changes in incidence of death or myocardial infarction. Use of DES is not associated with an increased risk of stent thrombosis at 1-year follow-up.