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

1 Citation (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

Fingerprint

Stents
Drug-Eluting Stents
Safety
Confidence Intervals
Percutaneous Coronary Intervention
Metals
Myocardial Infarction
ST Elevation Myocardial Infarction
Thrombosis
Sirolimus
Paclitaxel
Coronary Vessels
Randomized Controlled Trials

Keywords

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

Cite this

Chichareon, P., Modolo, R., Collet, C., Tenekecioglu, E., Vink, M. A., Oh, P. C., ... Serruys, P. W. (2019). Efficacy and safety of stents in ST-segment elevation myocardial infarction. Journal of the American College of Cardiology, 74(21), 2572-2584. https://doi.org/10.1016/j.jacc.2019.09.038
Chichareon, Ply ; Modolo, Rodrigo ; Collet, Carlos ; Tenekecioglu, Erhan ; Vink, Maarten A. ; Oh, Pyung Chun ; Ahn, Jung Min ; Musto, Carmine ; Díaz de la Llera, Luis S. ; Cho, Young Seok ; Violini, Roberto ; Park, Seung Jung ; Suryapranata, Harry ; Piek, Jan J. ; de Winter, Robbert J. ; Wykrzykowska, Joanna J. ; Spaulding, Christian ; Kang, Woong Chol ; Slagboom, Ton ; Hofma, Sjoerd H. ; Wijnbergen, Inge F. ; Di Lorenzo, Emilio ; Pijls, Nico H. ; Räber, Lorenz ; Brugaletta, Salvatore ; Sabaté, Manel ; Stoll, Hans Peter ; Stone, Gregg W. ; Windecker, Stephan ; Onuma, Yoshinobu ; Serruys, Patrick W. / Efficacy and safety of stents in ST-segment elevation myocardial infarction. In: Journal of the American College of Cardiology. 2019 ; Vol. 74, No. 21. pp. 2572-2584.
@article{9117c34c460b4b1da8f2829c0e289f37,
title = "Efficacy and safety of stents in ST-segment elevation myocardial infarction",
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)",
keywords = "bare-metal stents, drug-eluting stents, efficacy, individual patient data network meta-analysis, safety, ST-segment elevation myocardial infarction",
author = "Ply Chichareon and Rodrigo Modolo and Carlos Collet and Erhan Tenekecioglu and Vink, {Maarten A.} and Oh, {Pyung Chun} and Ahn, {Jung Min} and Carmine Musto and {D{\'i}az de la Llera}, {Luis S.} and Cho, {Young Seok} and Roberto Violini and Park, {Seung Jung} and Harry Suryapranata and Piek, {Jan J.} and {de Winter}, {Robbert J.} and Wykrzykowska, {Joanna J.} and Christian Spaulding and Kang, {Woong Chol} and Ton Slagboom and Hofma, {Sjoerd H.} and Wijnbergen, {Inge F.} and {Di Lorenzo}, Emilio and Pijls, {Nico H.} and Lorenz R{\"a}ber and Salvatore Brugaletta and Manel Sabat{\'e} and Stoll, {Hans Peter} and Stone, {Gregg W.} and Stephan Windecker and Yoshinobu Onuma and Serruys, {Patrick W.}",
year = "2019",
month = "11",
day = "26",
doi = "10.1016/j.jacc.2019.09.038",
language = "English",
volume = "74",
pages = "2572--2584",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier",
number = "21",

}

Chichareon, P, Modolo, R, Collet, C, Tenekecioglu, E, Vink, MA, Oh, PC, Ahn, JM, Musto, C, Díaz de la Llera, LS, Cho, YS, Violini, R, Park, SJ, Suryapranata, H, Piek, JJ, de Winter, RJ, Wykrzykowska, JJ, Spaulding, C, Kang, WC, Slagboom, T, Hofma, SH, Wijnbergen, IF, Di Lorenzo, E, Pijls, NH, Räber, L, Brugaletta, S, Sabaté, M, Stoll, HP, Stone, GW, Windecker, S, Onuma, Y & Serruys, PW 2019, 'Efficacy and safety of stents in ST-segment elevation myocardial infarction', Journal of the American College of Cardiology, vol. 74, no. 21, pp. 2572-2584. https://doi.org/10.1016/j.jacc.2019.09.038

Efficacy and safety of stents in ST-segment elevation myocardial infarction. / Chichareon, Ply; Modolo, Rodrigo; Collet, Carlos; Tenekecioglu, Erhan; Vink, Maarten A.; Oh, Pyung Chun; Ahn, Jung Min; Musto, Carmine; Díaz de la Llera, Luis S.; Cho, Young Seok; Violini, Roberto; Park, Seung Jung; Suryapranata, Harry; Piek, Jan J.; de Winter, Robbert J.; Wykrzykowska, Joanna J.; Spaulding, Christian; Kang, Woong Chol; Slagboom, Ton; Hofma, Sjoerd H.; Wijnbergen, Inge F.; Di Lorenzo, Emilio; Pijls, Nico H.; Räber, Lorenz; Brugaletta, Salvatore; Sabaté, Manel; Stoll, Hans Peter; Stone, Gregg W.; Windecker, Stephan; Onuma, Yoshinobu (Corresponding author); Serruys, Patrick W. (Corresponding author).

In: Journal of the American College of Cardiology, Vol. 74, No. 21, 26.11.2019, p. 2572-2584.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Efficacy and safety of stents in ST-segment elevation myocardial infarction

AU - Chichareon, Ply

AU - Modolo, Rodrigo

AU - Collet, Carlos

AU - Tenekecioglu, Erhan

AU - Vink, Maarten A.

AU - Oh, Pyung Chun

AU - Ahn, Jung Min

AU - Musto, Carmine

AU - Díaz de la Llera, Luis S.

AU - Cho, Young Seok

AU - Violini, Roberto

AU - Park, Seung Jung

AU - Suryapranata, Harry

AU - Piek, Jan J.

AU - de Winter, Robbert J.

AU - Wykrzykowska, Joanna J.

AU - Spaulding, Christian

AU - Kang, Woong Chol

AU - Slagboom, Ton

AU - Hofma, Sjoerd H.

AU - Wijnbergen, Inge F.

AU - Di Lorenzo, Emilio

AU - Pijls, Nico H.

AU - Räber, Lorenz

AU - Brugaletta, Salvatore

AU - Sabaté, Manel

AU - Stoll, Hans Peter

AU - Stone, Gregg W.

AU - Windecker, Stephan

AU - Onuma, Yoshinobu

AU - Serruys, Patrick W.

PY - 2019/11/26

Y1 - 2019/11/26

N2 - 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)

AB - 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)

KW - bare-metal stents

KW - drug-eluting stents

KW - efficacy

KW - individual patient data network meta-analysis

KW - safety

KW - ST-segment elevation myocardial infarction

UR - http://www.scopus.com/inward/record.url?scp=85074494525&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2019.09.038

DO - 10.1016/j.jacc.2019.09.038

M3 - Article

C2 - 31753202

AN - SCOPUS:85074494525

VL - 74

SP - 2572

EP - 2584

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 21

ER -