Abstract
Background: To date, no specific drug-eluting stent (DES) has fully proven its superiority over others in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention. Objectives: The purpose of this study was to compare the safety and efficacy of coronary artery stents in STEMI patients in a patient-level network meta-analysis. Methods: Eligible studies were dedicated randomized controlled trials comparing different stents in STEMI patients undergoing percutaneous coronary intervention with at least 12 months of clinical follow-up. Of 19 studies identified from the published data, individual patient data were collected in 15 studies with 10,979 patients representing 87.7% of patients in the overall network of evidence. The primary endpoint was the composite of cardiac death, reinfarction, or target lesion revascularization. Results: Overall, 8,487 (77.3%) of 10,979 STEMI patients were male and the mean age was 60.7 years. At a median follow-up of 3 years, compared with bare-metal stents (BMS), patients treated with paclitaxel-, sirolimus-, everolimus-, or biolimus-eluting stents had a significantly lower risk of the primary endpoint (adjusted hazard ratios [HRs]: 0.74 [95% confidence interval (CI): 0.63 to 0.88], 0.65 [95% CI: 0.49 to 0.85], 0.70 [95% CI: 0.53 to 0.91], and 0.66 [95% CI: 0.49 to 0.88], respectively). The risk of primary endpoint was not different between patients treated with BMS and zotarolimus-eluting stents (adjusted HR: 0.83 [95% CI: 0.51 to 1.38]). Among patients treated with DES, no significant difference in the risk of the primary outcome was demonstrated. Treatment with second-generation DES was associated with significantly lower risk of definite or probable stent thrombosis compared with BMS (adjusted HR: 0.61 [95% CI: 0.42 to 0.89]) and first-generation DES (adjusted HR: 0.56 [95% CI: 0.36 to 0.88]). Conclusions: In STEMI patients, DES were superior to BMS with respect to long-term efficacy. No difference in long-term efficacy and safety was observed among specific DES. Second-generation were superior to first-generation DES in reducing stent thrombosis. (Clinical Outcomes After Primary Percutaneous Coronary Intervention [PCI] Using Contemporary Drug-Eluting Stent [DES]: Evidence From the Individual Patient Data Network Meta-Analysis; CRD42018104053)
Original language | English |
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Pages (from-to) | 2572-2584 |
Number of pages | 13 |
Journal | Journal of the American College of Cardiology |
Volume | 74 |
Issue number | 21 |
DOIs | |
Publication status | Published - 26 Nov 2019 |
Funding
This study was funded by Biosensors international. The sponsor was not involved in analysis, interpretation of data, writing of the report nor in the decision to submit the paper for publication. Drs. Chichareon, Modolo, Collet, and Tenekecioglu have received a grant from Biosensors during the conduct of the study. Dr. Collet has received grants and personal fees from Heartflow Inc.; and has received personal fees from Philips and Abbott Vascular outside of the submitted work. Dr. Piek has received nonfinancial support from Abbott Vascular; and has received personal fees and nonfinancial support from Philips/Volcano outside of the submitted work. Dr. Spaulding has received grants and personal fees from Cordis, Johnson & Johnson, during the conduct of the study; has received personal fees from Stentys, Medtronic, Abbott, and Terumo; and has received grants from Biosensors and Boston Scientific outside of the submitted work. Dr. Hofma has received unrestricted research grants from Abbott Vascular to the Research Department of the Division of Cardiology of the Medical Center Leeuwarden, during the conduct of the XAMI study. Dr. Pijls has received grants from Abbott and Hexacath; has equity in Philips, ASML, General Electric, and Heart Flow; and has received consultant fees from Boston Scientific outside of the submitted work. Dr. R?ber has received grants to his institution from Abbott, Biotronik, Boston Scientific, Heartflow, Sanofi, and Regeneron; and has received speaker fees from Abbott, Amgen, AstraZeneca, CSL Behring, Sanofi, and Vifor. Dr. Sabat? has received personal fees from and served as a consultant for Abbott Vascular outside of the submitted work. Dr. Stoll is a full-time employee of Biosensors International. Dr. Stone has received personal fees from Terumo, Amaranth, Medical Development Technologies, Shockwave, Valfix, TherOx, Reva, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Matrizyme, Miracor, Neovasc, V-wave, Abiomed, Claret, Backbeat, Sirtex, Ancora, Qool Therapeutics, and SpectraWave; holds equity in Ancora, Qool Therapeutics, Cagent, Applied Therapeutics, Caliber, SpectraWave, Biostar family of funds, and MedFocus family of funds; is director of SpectraWave; and his institution, Columbia University, has received royalties from Abbott for sale of the MitraClip. Dr. Windecker has received grants from Amgen, Abbott, Boston Scientific, Bristol-Myers Squibb, Bayer, Biotronik, Edwards, Medtronic, Sinomed, and Polares outside of the submitted work. Dr. Onuma has served as a member of the Advisory Board of Abbott Vascular. Dr. Serruys has received personal fees from Abbott Laboratories, AstraZeneca, Biotronik, Cardialysis, GLG Research, Medtronic, Sino Medical Sciences Technology, Soci?t? Europa Digital Publishing, Stentys France, Svelte Medical Systems, Philips/Volcano, St. Jude Medical, Qualimed, and Xeltis outside of the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Keywords
- bare-metal stents
- drug-eluting stents
- efficacy
- individual patient data network meta-analysis
- safety
- ST-segment elevation myocardial infarction