title: Five-year outcomes for first generation drug-eluting stents versus bare-metal stents in patients with ST-segment elevation myocardial infarction: a meta-analysis of randomised controlled trials.
abstract: BACKGROUND
  Drug-eluting stent (DES) implantation has been proved more effective compared with bare-metal stent (BMS) implantation for ST-segment elevation myocardial infarction (STEMI) within medium follow up. However, limited information is available on the long-term safety and efficacy of DES.
  
  
  METHODS
  We performed a meta-analysis of randomised controlled trials (RCT) comparing DES with BMS in patients with STEMI at long-term follow up, defined as five years or more. The clinical end points were target vessel revascularisation (TVR), death, recurrent myocardial infarction (MI), stent thrombosis and very late stent thrombosis. We calculated the pooled estimate based on a fixed-effects model using odds ratio (OR) for rare events.
  
  
  RESULTS
  Four RCT were included, with a total of 1414 patients enrolled. Up to five years, DES showed a significant reduction in TVR (OR, 0.55; 95% confidence interval [CI], 0.55-0.77; P = 0.0005), but an increase in very late stent thrombosis (OR, 3.03; 95% CI, 1.28-7.18; P = 0.01), without increasing mortality (OR, 0.85; 95% CI, 0.59-1.20; P = 0.35), recurrent MI (OR, 1.05; 95% CI, 0.69-1.60; P = 0.80), and overall stent thrombosis (OR, 1.10; 95% CI, 0.66-1.82; P = 0.72).
  
  
  CONCLUSIONS
  At long-term follow-up, primary percutaneous coronary intervention with DES improved efficacy, without reducing overall safety. However, a trade-off must be made between the reduction of reintervention with DES and an increase in very late stent thrombosis.
authors: Department of Cardiology, Qianfoshan Hospital, Shandong University, PR China.
authors: Fei
authors: F
authors: Zheng
authors: Shandong University of Traditional Chinese Medicine, Jinan, PR China.
authors: Shanshan
authors: S
authors: Xing
authors: Department of Cardiology, Qianfoshan Hospital, Shandong University, PR China.
authors: Zushun
authors: Z
authors: Gong
authors: Department of Cardiology, Qianfoshan Hospital, Shandong University, PR China. Electronic address: xingqichong@126.com.
authors: Qichong
authors: Q
authors: Xing
mesh_terms: D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008955:Models, Cardiovascular; D009203:Myocardial Infarction / Q000401:mortality* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D016032:Randomized Controlled Trials as Topic; D013927:Thrombosis / Q000209:etiology / Q000401:mortality*
keywords: Bare-metal stents; Drug-eluting stents; Long-term; Meta-analysis