Efficacy and safety of stents in ST-segment elevation myocardial infarction

Ply Chichareon, Rodrigo Modolo, Carlos Collet, Erhan Tenekecioglu, Maarten A. Vink, Pyung Chun Oh, Jung Min Ahn, Carmine Musto, Luis S. Díaz de la Llera, Young Seok Cho, Roberto Violini, Seung Jung Park, Harry Suryapranata, Jan J. Piek, Robbert J. de Winter, Joanna J. Wykrzykowska, Christian Spaulding, Woong Chol Kang, Ton Slagboom, Sjoerd H. HofmaInge F. Wijnbergen, Emilio Di Lorenzo, Nico H. Pijls, Lorenz Räber, Salvatore Brugaletta, Manel Sabaté, Hans Peter Stoll, Gregg W. Stone, Stephan Windecker, Yoshinobu Onuma, Patrick W. Serruys

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Scopus)

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 languageEnglish
Pages (from-to)2572-2584
Number of pages13
JournalJournal of the American College of Cardiology
Volume74
Issue number21
DOIs
Publication statusPublished - 26 Nov 2019

Keywords

  • bare-metal stents
  • drug-eluting stents
  • efficacy
  • individual patient data network meta-analysis
  • safety
  • ST-segment elevation myocardial infarction

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