TY - JOUR
T1 - Efficacy and Safety of Stents in ST-Segment Elevation Myocardial Infarction
AU - Chichareon, Ply
AU - Modolo, Rodrigo
AU - Collet, Carlos
AU - Tenekecioglu, Erhan
AU - Vink, Maarten A.
AU - Oh, Pyung Chun
AU - Ahn, Jung Min
AU - Musto, Carmine
AU - Díaz de la Llera, Luis S.
AU - Cho, Young Seok
AU - Violini, Roberto
AU - Park, Seung Jung
AU - Suryapranata, Harry
AU - Piek, Jan J.
AU - de Winter, Robbert J.
AU - Wykrzykowska, Joanna J.
AU - Spaulding, Christian
AU - Kang, Woong Chol
AU - Slagboom, Ton
AU - Hofma, Sjoerd H.
AU - Wijnbergen, Inge F.
AU - Di Lorenzo, Emilio
AU - Pijls, Nico H.
AU - Räber, Lorenz
AU - Brugaletta, Salvatore
AU - Sabaté, Manel
AU - Stoll, Hans Peter
AU - Stone, Gregg W.
AU - Windecker, Stephan
AU - Onuma, Yoshinobu
AU - Serruys, Patrick W.
PY - 2019/11/26
Y1 - 2019/11/26
N2 - Background: To date, no specific drug-eluting stent (DES) has fully proven its superiority over others in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention. Objectives: The purpose of this study was to compare the safety and efficacy of coronary artery stents in STEMI patients in a patient-level network meta-analysis. Methods: Eligible studies were dedicated randomized controlled trials comparing different stents in STEMI patients undergoing percutaneous coronary intervention with at least 12 months of clinical follow-up. Of 19 studies identified from the published data, individual patient data were collected in 15 studies with 10,979 patients representing 87.7% of patients in the overall network of evidence. The primary endpoint was the composite of cardiac death, reinfarction, or target lesion revascularization. Results: Overall, 8,487 (77.3%) of 10,979 STEMI patients were male and the mean age was 60.7 years. At a median follow-up of 3 years, compared with bare-metal stents (BMS), patients treated with paclitaxel-, sirolimus-, everolimus-, or biolimus-eluting stents had a significantly lower risk of the primary endpoint (adjusted hazard ratios [HRs]: 0.74 [95% confidence interval (CI): 0.63 to 0.88], 0.65 [95% CI: 0.49 to 0.85], 0.70 [95% CI: 0.53 to 0.91], and 0.66 [95% CI: 0.49 to 0.88], respectively). The risk of primary endpoint was not different between patients treated with BMS and zotarolimus-eluting stents (adjusted HR: 0.83 [95% CI: 0.51 to 1.38]). Among patients treated with DES, no significant difference in the risk of the primary outcome was demonstrated. Treatment with second-generation DES was associated with significantly lower risk of definite or probable stent thrombosis compared with BMS (adjusted HR: 0.61 [95% CI: 0.42 to 0.89]) and first-generation DES (adjusted HR: 0.56 [95% CI: 0.36 to 0.88]). Conclusions: In STEMI patients, DES were superior to BMS with respect to long-term efficacy. No difference in long-term efficacy and safety was observed among specific DES. Second-generation were superior to first-generation DES in reducing stent thrombosis. (Clinical Outcomes After Primary Percutaneous Coronary Intervention [PCI] Using Contemporary Drug-Eluting Stent [DES]: Evidence From the Individual Patient Data Network Meta-Analysis; CRD42018104053)
AB - Background: To date, no specific drug-eluting stent (DES) has fully proven its superiority over others in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention. Objectives: The purpose of this study was to compare the safety and efficacy of coronary artery stents in STEMI patients in a patient-level network meta-analysis. Methods: Eligible studies were dedicated randomized controlled trials comparing different stents in STEMI patients undergoing percutaneous coronary intervention with at least 12 months of clinical follow-up. Of 19 studies identified from the published data, individual patient data were collected in 15 studies with 10,979 patients representing 87.7% of patients in the overall network of evidence. The primary endpoint was the composite of cardiac death, reinfarction, or target lesion revascularization. Results: Overall, 8,487 (77.3%) of 10,979 STEMI patients were male and the mean age was 60.7 years. At a median follow-up of 3 years, compared with bare-metal stents (BMS), patients treated with paclitaxel-, sirolimus-, everolimus-, or biolimus-eluting stents had a significantly lower risk of the primary endpoint (adjusted hazard ratios [HRs]: 0.74 [95% confidence interval (CI): 0.63 to 0.88], 0.65 [95% CI: 0.49 to 0.85], 0.70 [95% CI: 0.53 to 0.91], and 0.66 [95% CI: 0.49 to 0.88], respectively). The risk of primary endpoint was not different between patients treated with BMS and zotarolimus-eluting stents (adjusted HR: 0.83 [95% CI: 0.51 to 1.38]). Among patients treated with DES, no significant difference in the risk of the primary outcome was demonstrated. Treatment with second-generation DES was associated with significantly lower risk of definite or probable stent thrombosis compared with BMS (adjusted HR: 0.61 [95% CI: 0.42 to 0.89]) and first-generation DES (adjusted HR: 0.56 [95% CI: 0.36 to 0.88]). Conclusions: In STEMI patients, DES were superior to BMS with respect to long-term efficacy. No difference in long-term efficacy and safety was observed among specific DES. Second-generation were superior to first-generation DES in reducing stent thrombosis. (Clinical Outcomes After Primary Percutaneous Coronary Intervention [PCI] Using Contemporary Drug-Eluting Stent [DES]: Evidence From the Individual Patient Data Network Meta-Analysis; CRD42018104053)
KW - ST-segment elevation myocardial infarction
KW - bare-metal stents
KW - drug-eluting stents
KW - efficacy
KW - individual patient data network meta-analysis
KW - safety
UR - http://www.scopus.com/inward/record.url?scp=85074494525&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jacc.2019.09.038
DO - https://doi.org/10.1016/j.jacc.2019.09.038
M3 - Article
C2 - 31753202
SN - 0735-1097
VL - 74
SP - 2572
EP - 2584
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 21
ER -