title: Use of drug-eluting stents in acute myocardial infarction: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The primary aim of the analysis was to compare outcomes by stent type for death, myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis in randomized trials of ST-segment elevation myocardial infarction (STEMI). A secondary analysis was performed among registry studies.
  
  
  BACKGROUND
  It is not known whether there are differences in outcomes between drug-eluting stents (DES) and bare-metal stents (BMS) for STEMI.
  
  
  METHODS
  We searched MEDLINE, EMBASE, the Cochrane Library, and Internet sources for articles comparing outcomes between DES and BMS among patients with STEMI between January 2000 and October 2008. Randomized controlled trials and registries including patients 18 years of age and older receiving a DES or BMS were included. We extracted variables related to the study design, setting, participants, and clinical end points.
  
  
  RESULTS
  Thirteen randomized trials were identified (N = 7,352). Compared with BMS, DES significantly reduced TVR (relative risk [RR]: 0.44; 95% confidence interval [CI]: 0.35 to 0.55), without increasing death (RR: 0.89; 95% CI: 0.70 to 1.14), MI (RR: 0.82; 95% CI: 0.64 to 1.05), or stent thrombosis (RR: 0.97; 95% CI: 0.73 to 1.28). These observations were durable over 2 years. Among 18 registries (N = 26,521), DES significantly reduced TVR (RR: 0.54; 95% CI: 0.40 to 0.74) without an increase in MI (RR: 0.87, 95% CI: 0.62 to 1.23). Death was significantly lower in the DES group within 1 year of the index percutaneous coronary intervention, but there were no differences within 2 years (p = 0.45).
  
  
  CONCLUSIONS
  The use of DES appears safe and efficacious in randomized trials and registries of patients with STEMI. The DES significantly reduce TVR compared with BMS, without an increase in death, MI, or stent thrombosis within 2 years of the index procedure.
authors.affiliation: Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, New York 10032, USA. SBrar@cvri.org
authors.forename: Somjot S
authors.initials: SS
authors.lastname: Brar
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Simerjeet K
authors.initials: SK
authors.lastname: Brar
authors.forename: George
authors.initials: G
authors.lastname: Dangas
mesh_terms: D016001:Confidence Intervals; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012042:Registries; D012044:Regression Analysis; D012306:Risk