Comprehensive meta-analysis on drug-eluting stents versus bare-metal stents during extended follow-up.
BACKGROUND
Several observational reports have documented both increased and decreased cardiac mortality or Q-wave myocardial infarction with drug-eluting stents compared with bare-metal stents.


METHODS
We sought to evaluate the safety and efficacy of drug-eluting stents compared with bare-metal stents early after intervention (<1 year) and late (>1 year) among a broad population of patients, using a meta-analysis of randomized clinical trials.


RESULTS
We identified 28 trials with a total of 10,727 patients and a mean follow-up of 29.6 months. For early outcomes (<1 year), all-cause mortality for drug-eluting stents versus bare-metal stents was 2.1% versus 2.4% (risk ratio [RR] 0.91, [95% confidence interval (CI), 0.70-1.18]; P=.47), non-Q-wave myocardial infarction was 3.3% versus 4.4% (RR 0.78 [95% CI, 0.61-1.00]; P=.055), target lesion revascularization was 5.8% versus 18.4% (RR 0.28 [95% CI, 0.21-0.38]; P <.001), and stent thrombosis was 1.1% versus 1.3% (RR 0.87 [95% CI, 0.60-1.26]; P=.47). For late outcomes (>1 year), all-cause mortality for drug-eluting stents versus bare-metal stents was 5.9% versus 5.7% (RR 1.03 [95% CI, 0.83-1.28]; P=.79), target lesion revascularization was 4.0% versus 3.3% (RR 1.22 [95% CI, 0.92-1.60]; P=.16), non-Q-wave myocardial infarction was 1.6% versus 1.2% (RR 1.36 [95% CI, 0.74-2.53]; P=.32) and stent thrombosis was 0.7% versus 0.1% (RR 4.57 [95% CI, 1.54-13.57]; P=.006).


CONCLUSIONS
There was no excess mortality with drug-eluting stents. Within 1 year, drug-eluting stents appear to be safe and efficacious with possibly decreased non-Q-wave myocardial infarction compared with bare-metal stents. After 1 year, drug-eluting stents still have similar mortality, despite increased stent thrombosis. The reduction in target lesion revascularization with drug-eluting stents mainly happens within 1 year, but is sustained thereafter.
Roukoz
Henri
H
Department of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Bavry
Anthony A
AA
Sarkees
Michael L
ML
Mood
Girish R
GR
Kumbhani
Dharam J
DJ
Rabbat
Mark G
MG
Bhatt
Deepak L
DL
D016001:Confidence Intervals; D023903:Coronary Restenosis / Q000209:etiology / Q000401:mortality; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D008910:Minnesota / Q000453:epidemiology; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D015996:Survival Rate; D013997:Time Factors