Drug-eluting stents versus bare-metal stents in acute myocardial infarction: A systematic review and meta-analysis.
OBJECTIVE
Recent concerns have been raised for the safety after drug-eluting stents (DES) implantation compared with the use of bare-metal stents (BMS) in patients with ST-elevation acute myocardial infarction (STEMI). The objective of this study was to estimate the relative impact of DES versus BMS on mortality, myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis (ST) in STEMI patients by performing comprehensive meta-analyses of randomized controlled trials (RCTs) and observational studies.


METHODS
We performed an electronic search and manual search of studies presented through September 2009, without language restrictions. An approach of "using systematic reviews" was used. Two independent reviewers extracted prespecified data from each study. A random-effects model was used to combine trials and to perform stratified analyses based on study designs and the duration of follow-up.


RESULTS
Fourteen RCTs were identified (N = 7,654). Compared with BMS, DES significantly reduced TVR (risk ratio [RR], 0.48; 95 percent confidence interval [CI], 0.41-0.56) and MI (RR, 0.77; 95 percent CI, 0.61-0.97), without increasing mortality (RR, 0.88; 95 percent CI, 0.70-1.10) and ST (RR, 0.93; 95 percent CI, 0.72-1.21). Among 35 observational studies (N = 44,849), the use of DES was associated with a significant reduction in mortality (RR, 0.85; 95 percent CI, 0.79-0.91) and TVR (RR, 0.61; 95 percent CI, 0.48-0.77). MI and ST were significantly lower in the DES group within 1-year follow-up, but there were no differences within 2 years of follow-up. There was no evidence of statistical heterogeneity and publication bias.


CONCLUSIONS
These data in aggregate suggest that using DES in STEMI patients is safe and efficacious, but there are differences between RCT and observational data comparing DES and BMS.
National Evidence-based Healthcare Collaborating Agency, Jongno-Gu, Seoul 110-450, South Korea. haesun.suh@neca.re.kr
Hae Sun
HS
Suh
Hyun Jin
HJ
Song
Ji Eun
JE
Choi
Eun Jin
EJ
Jang
Hee Jeong
HJ
Son
Sang Moo
SM
Lee
Jung-Sun
JS
Kim
Donghoon
D
Choi
D000208:Acute Disease; D054855:Drug-Eluting Stents / Q000592:standards*; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome