title: Stent thrombosis with second-generation drug-eluting stents compared with bare-metal stents: network meta-analysis of primary percutaneous coronary intervention trials in ST-segment–elevation myocardial infarction [corrected].
abstract: BACKGROUND
  The relative safety of drug-eluting stents (DESs) and bare-metal stents (BMSs) with respect to stent thrombosis (ST) continues to be debated. There are limited data comparing safety and efficacy of second-generation DES to BMS. We compared the clinical outcomes between second-generation DES and BMS for primary percutaneous coronary intervention using network meta-analysis.
  
  
  RESULTS
  Randomized controlled trials comparing stent types (first-generation DES, second-generation DES or BMS) were considered for inclusion. A search strategy used Medline, Embase, Cochrane databases, and proceedings of the international meetings. Information about study design, inclusion criteria, and sample characteristics were extracted. Network meta-analysis was used to pool direct (comparison of second-generation DES to BMS) and indirect evidence (first-generation DES with BMS and second-generation DES) from the randomized trials. Twenty-one trials comparing all stents types, including 12 866 patients randomly assigned to treatment groups, were analyzed. A significantly lower incidence of ST was noted with the use of second-generation DES as early as 30 days (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.15-0.82) and between 31 days and 1 year (OR, 0.49; 95% CI, 0.30-0.79) when compared with BMS. Second-generation DES was associated with significantly lower incidence of definite ST at 1 year (OR, 0.3; 95% CI, 0.11-0.83) and myocardial infarction (OR, 0.3; 95% CI, 0.17-0.54) and target vessel revascularization at 1 year (OR, 0.54; 95% CI, 0.80-0.98) when compared with BMS. There was no difference in mortality at 30 days (OR, 0.84; 95% CI, 0.45-1.59) or 1 year (OR, 0.80; 95% CI, 0.56-1.14) with the use of second-generation DES versus BMS. The small number of events may influence the precision of the analysis.
  
  
  CONCLUSIONS
  Network meta-analysis of randomized trials of primary percutaneous coronary intervention demonstrated lower incidence of ST, myocardial infarction, and target vessel revascularization with second-generation DES when compared with BMS. The use of second-generation DES for percutaneous coronary intervention in ST-segment-elevation myocardial infarction was not associated with adverse events when compared with BMS.
authors.affiliation: From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH.
authors.forename: Femi
authors.initials: F
authors.lastname: Philip
authors.forename: Shikhar
authors.initials: S
authors.lastname: Agarwal
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Bunte
authors.forename: Matthew
authors.initials: M
authors.lastname: Bunte
authors.forename: Sachin S
authors.initials: SS
authors.lastname: Goel
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.forename: Stephen
authors.initials: S
authors.lastname: Ellis
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
mesh_terms: D002986:Clinical Trials as Topic; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data; D004562:Electrocardiography; D006801:Humans; D008670:Metals; D009203:Myocardial Infarction / Q000209:etiology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000601:surgery*; D019919:Prosthesis Implantation; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: percutaneous coronary intervention