Meta-analysis of randomized trials on drug-eluting stents vs. bare-metal stents in patients with acute myocardial infarction.
OBJECTIVE
To compare the efficacy and safety of drug-eluting stents vs. bare-metal stents in patients with acute ST-segment elevation myocardial infarction.


RESULTS
We performed a meta-analysis of eight randomized trials comparing drug-eluting stents (sirolimus-eluting or paclitaxel-eluting stents) with bare-metal stents in 2786 patients with acute ST-segment elevation myocardial infarction. All patients were followed up for a mean of 12.0-24.2 months. Individual data were available for seven trials with 2476 patients. The primary efficacy endpoint was the need for reintervention (target lesion revascularization). The primary safety endpoint was stent thrombosis. Other outcomes of interest were death and recurrent myocardial infarction. Drug-eluting stents significantly reduced the risk of reintervention, hazard ratio of 0.38 (95% CI, 0.29-0.50), P < 0.001. The overall risk of stent thrombosis: hazard ratio of 0.80 (95% CI, 0.46-1.39), P = 0.43; death: hazard ratio of 0.76 (95% CI, 0.53-1.10), P = 0.14; and recurrent myocardial infarction: hazard ratio of 0.72 (95% CI, 0.48-1.08, P = 0.11) was not significantly different for patients receiving drug-eluting stents vs. bare-metal stents.


CONCLUSIONS
The use of drug-eluting stents in patients with acute ST-segment elevation myocardial infarction is safe and improves clinical outcomes by reducing the risk of reintervention compared with bare-metal stents.
Kastrati
Adnan
A
Deutsches Herzzentrum, Technische Universität, Lazarettstr.36, Munich 80636, Germany. kastrati@dhm.mhn.de
Dibra
Alban
A
Spaulding
Christian
C
Laarman
Gerrit J
GJ
Menichelli
Maurizio
M
Valgimigli
Marco
M
Di Lorenzo
Emilio
E
Kaiser
Christoph
C
Tierala
Ilkka
I
Mehilli
Julinda
J
Seyfarth
Melchior
M
Varenne
Olivier
O
Dirksen
Maurits T
MT
Percoco
Gianfranco
G
Varricchio
Attilio
A
Pittl
Undine
U
Syvänne
Mikko
M
Suttorp
Maarten J
MJ
Violini
Roberto
R
Schömig
Albert
A
D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality; D023903:Coronary Restenosis / Q000401:mortality / Q000517:prevention & control; D054855:Drug-Eluting Stents; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome