Short and long-term benefits of sirolimus-eluting stent in ST-segment elevation myocardial infarction: a meta-analysis of randomized trials.
BACKGROUND
Recent concerns have emerged on the potential higher risk of stent thrombosis after DES implantation, that might be even more pronounced among STEMI patients. The aim of the current study was to perform a meta-analysis to evaluate the benefits and safety of Sirolimus-Eluting Stent (SES) as compared to BMS in patients undergoing primary angioplasty for STEMI.


METHODS
The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL). We examined all completed randomized trials of DES for STEMI. The following keywords were used for study selection: randomized trial, myocardial infarction, reperfusion, primary angioplasty, stenting, DES, sirolimus-eluting stent (SES), Cypher. Information on study design, type of stent, inclusion and exclusion criteria, primary endpoint, number of patients, angiographic and clinical outcome, were extracted by two investigators. Disagreements were resolved by consensus.


RESULTS
A total of 9 trials were included in the meta-analysis, involving 2,769 patients (1389 or 50.2% randomized to DES and 1,380 or 49.8% randomized to BMS). At 12 months follow-up, SES was associated with a significant reduction in TVR (4.9% vs. 13.6%, p < 0.0001), with a trend in benefits in mortality (2.9% vs. 4.2%, p = 0.08) and reinfarction (3.0% vs. 4.3%, p = 0.06), without any significant difference in stent thrombosis (1.9% vs. 2.5%, p = 0.36). Safety and efficacy of DES were confirmed at 2-3 years follow-up (data available from 4 trials including 569 patients).


CONCLUSIONS
This meta-analysis shows that among selected STEMI patients undergoing primary angioplasty, SES as compared to BMS is safe and associated with a significant reduction in TVR at 1 and 2-3 years follow-up.
De Luca
Giuseppe
G
Division of Cardiology, Ospedale Maggiore della Carità, Eastern Piedmont University, Novara, Italy. giuseppe.deluca@maggioreosp.novara.it
Valgimigli
Marco
M
Spaulding
Christian
C
Menichelli
Maurizio
M
Brunner-La Rocca
Hans Peter
HP
van der Hoeven
Bas L
BL
Di Lorenzo
Emilio
E
Diaz de la Llera
Luis-S
LS
Pasceri
Vincenzo
V
Pittl
Undine
U
Percoco
Gianfranco
G
Violini
Roberto
R
Stone
Gregg W
GW
D015906:Angioplasty, Balloon, Coronary; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D020123:Sirolimus / Q000008:administration & dosage*; D013927:Thrombosis / Q000209:etiology
D000903:Antibiotics, Antineoplastic; D020123:Sirolimus