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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Use of Drug-Eluting Stents in Acute Myocardial Infarction

A Systematic Review and Meta-Analysis

Center for Interventional Vascular Therapy, Columbia University Medical Center, and the Cardiovascular Research Foundation, New York, New York

Manuscript received January 27, 2009; revised manuscript received February 25, 2009, accepted March 2, 2009.

^_* Reprint requests and correspondence: Dr. Somjot S. Brar, Center for Interventional Vascular Therapy, Columbia University Medical Center, 161 Fort Washington Avenue, 5th Floor, New York, New York 10032 (Email: SBrar{at}cvri.org).

Objectives: The primary aim of the analysis was to compare outcomes by stent type for death, myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis in randomized trials of ST-segment elevation myocardial infarction (STEMI). A secondary analysis was performed among registry studies.

Background: It is not known whether there are differences in outcomes between drug-eluting stents (DES) and bare-metal stents (BMS) for STEMI.

Methods: We searched MEDLINE, EMBASE, the Cochrane Library, and Internet sources for articles comparing outcomes between DES and BMS among patients with STEMI between January 2000 and October 2008. Randomized controlled trials and registries including patients 18 years of age and older receiving a DES or BMS were included. We extracted variables related to the study design, setting, participants, and clinical end points.

Results: Thirteen randomized trials were identified (N = 7,352). Compared with BMS, DES significantly reduced TVR (relative risk [RR]: 0.44; 95% confidence interval [CI]: 0.35 to 0.55), without increasing death (RR: 0.89; 95% CI: 0.70 to 1.14), MI (RR: 0.82; 95% CI: 0.64 to 1.05), or stent thrombosis (RR: 0.97; 95% CI: 0.73 to 1.28). These observations were durable over 2 years. Among 18 registries (N = 26,521), DES significantly reduced TVR (RR: 0.54; 95% CI: 0.40 to 0.74) without an increase in MI (RR: 0.87, 95% CI: 0.62 to 1.23). Death was significantly lower in the DES group within 1 year of the index percutaneous coronary intervention, but there were no differences within 2 years (p = 0.45).

Conclusions: The use of DES appears safe and efficacious in randomized trials and registries of patients with STEMI. The DES significantly reduce TVR compared with BMS, without an increase in death, MI, or stent thrombosis within 2 years of the index procedure.

Key Words: stent • drug-eluting • myocardial infarction • meta-analysis • systematic review • meta-regression

Abbreviations and Acronyms   BMS = bare-metal stent(s)   CI = confidence interval   DES = drug-eluting stent(s)   MI = myocardial infarction   NNT = number needed to treat   PCI = percutaneous coronary intervention   RCT = randomized controlled trial   RD = risk difference   RR = relative risk   STEMI = ST-segment elevation myocardial infarction   TIMI = Thrombolysis In Myocardial Infarction   TVR = target vessel revascularization

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J. Am. Coll. Cardiol. 2009 53: A24. [Full Text] [PDF]