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Comparison of drug-eluting stents with bare metal stents in patients with ST-segment elevation myocardial infarction

Kalesan, Bindu ; Pilgrim, Thomas ; Heinimann, Katja ; Räber, Lorenz ; Stefanini, Giulio G. ; Valgimigli, Marco ; da Costa, Bruno R. ; Mach, François ; Lüscher, Thomas F. ; Meier, Bernhard ; Windecker, Stephan ; Jüni, Peter

In: European Heart Journal, 2012, vol. 33, no. 8, p. 977-987

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    Titre
    • Comparison of drug-eluting stents with bare metal stents in patients with ST-segment elevation myocardial infarction
    Auteur
    • Kalesan, Bindu. Department of Cardiology, Bern University Hospital, Bern, Switzerland
    • Pilgrim, Thomas. Department of Cardiology, Bern University Hospital, Bern, Switzerland
    • Heinimann, Katja. Institute of Social and Preventive Medicine, University of Bern, Switzerland
    • Räber, Lorenz. Department of Cardiology, Bern University Hospital, Bern, Switzerland
    • Stefanini, Giulio G.. Department of Cardiology, Bern University Hospital, Bern, Switzerland
    • Valgimigli, Marco. Department of Cardiology, University Hospital of Ferrara, Italy
    • da Costa, Bruno R.. Institute of Social and Preventive Medicine, University of Bern, Switzerland
    • Mach, François. Department of Cardiology, University Hospital of Geneva, Switzerland
    • Lüscher, Thomas F.. Department of Cardiology, University Hospital of Zurich, Switzerland
    • Meier, Bernhard. Department of Cardiology, Bern University Hospital, Bern, Switzerland
    • Windecker, Stephan. Department of Cardiology, Bern University Hospital, Bern, Switzerland
    • Jüni, Peter. Clinical Trials Unit, University of Bern, Bern, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Heart Journal, 2012, vol. 33, no. 8, p. 977-987. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:301859
    Summary
    Aims To evaluate safety and effectiveness of early generation drug-eluting stents (DES) compared with bare-metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), and to determine whether benefits and risks vary over time. Methods and results We performed a meta-analysis of 15 randomized controlled trials enrolling a total of 7867 patients comparing first-generation FDA-approved DES with BMS in patients with STEMI. Random effect models were used to assess differences in outcomes between DES and BMS among different time periods with regard to the pre-specified primary outcomes stent thrombosis (ST) and target vessel revascularization (TVR). The overall risk of definite ST was similar for DES and BMS [risk ratio (RR) = 1.08, 95% CI 0.82-1.43]. However, there were time-dependent effects, with a RR of 0.80 during the first year (95% CI 0.58-1.12) and 2.10 during subsequent years (95% CI 1.20-3.69), with a positive test for interaction between RR of ST and time (P for interaction = 0.009). Results were similar for definite or probable ST (P for interaction = 0.015). In the overall analysis, TVR was performed less frequently in patients with DES when compared with BMS (RR 0.51, 95% CI 0.43-0.61), with a greater benefit in the first year (RR 0.46, 95% CI 0.38-0.55) when compared with subsequent years (RR 0.75, 95% CI 0.59-0.94; P for interaction = 0.007). Conclusion An early benefit of early generation DES in primary PCI for STEMI with a reduction in TVR and a trend towards less definite ST is offset in subsequent years by an increased risk of very late ST