title: A Meta-Analysis of Randomized Controlled Trials of Conventional Stenting Versus Direct Stenting in Patients With Acute Myocardial Infarction.
abstract: BACKGROUND
  Direct stenting (DS) is commonly used during percutaneous coronary intervention for acute myocardial infarction (AMI) to prevent distal embolization; however, no guideline recommendations exist regarding DS. We sought to compare DS with conventional stenting (CS) in patients presenting with AMI in a meta-analysis of randomized controlled trials.
  
  
  METHODS
  Studies were identified from EMBASE, MEDLINE, and Cochrane databases. To be included, randomized controlled trials must have compared DS with CS in patients with AMI. Data were extracted and articles were critically appraised by two authors. A fixed effects model was used, with Peto odds ratios (ORs). The primary endpoint was death from cardiovascular causes.
  
  
  RESULTS
  Five trials (n = 754) met the eligibility criteria. ST-segment resolution occurred in 68.9% (146/212) in the DS group vs 60.2% (127/211) in the CS group (OR, 1.51; 95% CI, 1.00-2.27; P=.05; I²=52%). No-reflow occurred in 6.6% in the DS group compared with 6.9% in the CS group (OR, 0.78; 95% CI, 0.39-1.55; P=.48; I²=0%). DS was associated with a significant reduction in the risk of in-hospital cardiovascular death (OR, 0.21; 95% CI, 0.06-0.77; P=.02; I²=0%). No significant differences were observed in myocardial infarction (OR, 0.38; 95% CI, 0.09-1.51; P=.17; I²=7%) or target lesion revascularization (OR, 1.20; 95% CI, 0.36-3.97; P=.76; I²=0%).
  
  
  CONCLUSIONS
  Small trials suggest a potential benefit to DS in AMI. Further large-scale randomized trials are warranted to confirm the benefit of this approach.
authors.forename: Aiman
authors.initials: A
authors.lastname: Alak
authors.forename: Peter
authors.initials: P
authors.lastname: Lugomirski
authors.forename: Natasha
authors.initials: N
authors.lastname: Aleksova
authors.affiliation: Department of Medicine, McMaster University, Rm. C3-118 DBCSVRI Building, Hamilton General, Hospital, 237 Barton St. East, Hamilton, Ontario, Canada, L8L 2X2. sanjit.jolly@phri.ca.
authors.forename: Sanjit S
authors.initials: SS
authors.lastname: Jolly
mesh_terms: D057186:Comparative Effectiveness Research; D017023:Coronary Angiography; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D015607:Stents