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Efficacy and safety of drug-eluting stents in patients with acute ST-segment-elevation myocardial infarction: a meta-analysis of randomized controlled trials.

Abstract
We compared the efficacy and safety of drug-eluting stents with that of bare-metal stents in patients who experienced acute ST-segment-elevation myocardial infarction (STEMI) and underwent primary percutaneous coronary intervention. To do this, we performed a meta-analysis of 13 randomized controlled trials in which drug-eluting stents were compared with bare-metal stents in STEMI patients. The trials involved 6,769 patients (4,246 received drug-eluting stents and 2,523 received bare-metal stents) and follow-up periods of 6 to 48 months. In comparison with bare-metal stents, drug-eluting stents significantly reduced the incidence of major adverse cardiac events, with a risk ratio (RR) of 0.59 (95% confidence interval [CI], 0.47-0.73; P < 0.00001). Drug-eluting stents were not associated with a significant reduction in overall death (RR = 0.94; 95% CI, 0.74-1.20; P = 0.64), but were associated with significant reductions in recurrent myocardial infarction (RR = 0.76; 95% CI, 0.58-0.98; P = 0.03), target-vessel revascularization (RR = 0.47; 95% CI, 0.39-0.56; P <0.00001), and in-stent restenosis (RR = 0.32; 95% CI, 0.25-0.39; P < 0.00001). Moreover, no significant difference was found in the comparative risk of stent thrombosis (RR = 0.85; 95% CI, 0.63-1.14; P = 0.27).On the basis of risk ratio, we conclude that using drug-eluting stents in STEMI patients who undergo primary percutaneous coronary intervention is safe with regard to stent thrombosis within 48 months, and that drug-eluting stents improve clinical outcomes by reducing the risks of major adverse cardiac events, recurrent myocardial infarction, reintervention, and in-stent restenosis, compared with bare-metal stents. However, in order to investigate possible very late stent thrombosis, follow-up of these trials beyond 48 months is warranted.
AuthorsPan-Pan Hao, Yu-Guo Chen, Xing-Li Wang, Yun Zhang
JournalTexas Heart Institute journal (Tex Heart Inst J) Vol. 37 Issue 5 Pg. 516-24 ( 2010) ISSN: 1526-6702 [Electronic] United States
PMID20978561 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review)
Chemical References
  • Metals
Topics
  • Angioplasty, Balloon, Coronary (adverse effects, instrumentation, mortality)
  • Chi-Square Distribution
  • Coronary Restenosis (etiology, prevention & control)
  • Drug-Eluting Stents
  • Evidence-Based Medicine
  • Humans
  • Metals
  • Middle Aged
  • Myocardial Infarction (mortality, therapy)
  • Odds Ratio
  • Prosthesis Design
  • Randomized Controlled Trials as Topic
  • Recurrence
  • Risk Assessment
  • Risk Factors
  • Stents
  • Thrombosis (etiology, prevention & control)
  • Time Factors
  • Treatment Outcome

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