title: Clinical outcomes of second- versus first-generation drug-eluting stents in patients with acute myocardial infarction: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  It remains unclear whether the clinical outcomes of patients with acute myocardial infarction (AMI) receiving second- and first-generation drug-eluting stents (DES) are identical. The study aimed to investigate the differences in clinical utility between the two generations of DES in these specific subjects by a meta-analysis.
  
  
  METHODS
  We systemically searched PubMed and EMBASE databases and the Cochrane Library up until January 2013. Randomized trials, which compared clinical outcomes of second-generation DES (everolimus- (EES) or zotarolimus-eluting stents (ZES)) with first-generation DES (sirolimus- or paclitaxel-eluting stents) in patients with AMI were included.
  
  
  RESULTS
  Five trials with 1720 AMI subjects were included in the meta-analysis. Pooled analysis demonstrated a trend toward lower incidence of stent thrombosis with the second-generation DES relative to the first-generation one (risk ratio (RR), 0.53; 95% confidence intervals (CI): 0.25-1.13; p = 0.10). However, the second-generation DES did not offer a significant advantage over the first-generation DES in reducing the incidence of target lesion revascularization (TLR) (RR = 1.73; 95% CI: 0.83-3.64; p = 0.15), major adverse cardiac events (MACEs) (RR = 0.97; p = 0.90), or all-cause death (RR = 1.00; p = 1.0). In addition, in elderly patients the second-generation DES seemed to reduce the occurrence of MACEs (RR = 0.65; p = 0.10) and stent thrombosis (RR = 0.40; p = 0.08), and the second-generation EES showed a potential benefit in lowering the MACE rate (RR = 0.55; p = 0.06).
  
  
  CONCLUSIONS
  The second-generation DES appeared to lower the risk of stent thrombosis in AMI patients. There might be a lower incidence of MACEs associated with the second-generation EES.
authors.affiliation: Department of Cardiology, First Hospital of Jilin University, Changchun, China.
authors.forename: Guodong
authors.initials: G
authors.lastname: Wu
authors.affiliation: Department of Cardiology, First Hospital of Jilin University, Changchun, China.
authors.forename: Guoqiang
authors.initials: G
authors.lastname: Sun
authors.affiliation: Department of Endoscopy and Gastroenterology, First Hospital of Jilin University, Changchun, China.
authors.forename: Ruihong
authors.initials: R
authors.lastname: Zhao
authors.affiliation: Emergency Department, First Hospital of Jilin University, Changchun, China.
authors.forename: Mingli
authors.initials: M
authors.lastname: Sun
keywords: acute myocardial infarction; meta-analysis; second-generation drug-eluting stents