PUBMED, EMBASE, and CENTRAL were searched for randomized clinical trials, until March 2013, comparing any of the 5 Food and Drug Administration-approved durable
stent and
polymer DES (
sirolimus eluting
stent,
paclitaxel eluting
stent,
everolimus-eluting
stent [EES],
zotarolimus-eluting
stent, and
zotarolimus-eluting
stent resolute), against each other or bare
metal stents (BMS), and enrolling ≥ 50 patients with
STEMI. Efficacy (target vessel revascularization) and safety (death,
myocardial infarction, and
stent thrombosis) outcomes at the longest reported follow-up times were evaluated. Twenty-eight randomized clinical trials with 34 068 patient-years of follow-up on subjects with
STEMI fulfilled the inclusion criteria. When compared with BMS (reference rate ratio [RR] of 1),
sirolimus eluting
stent (RR, 0.46; 95% credibility interval [CrI], 0.36-0.56),
paclitaxel eluting
stent (RR, 0.69; 95% CrI, 0.53-0.87), and EES (RR, 0.42; 95% CrI, 0.26-0.62) were associated with a statistically significant reduction in rate of target vessel revascularization, with the point estimate for
zotarolimus-eluting
stent resolute trending in a similar direction. There was no increase in the risk of death,
myocardial infarction, or
stent thrombosis with any DES compared with BMS. Moreover, EES was associated with a statistically significant reduction in the rate of
stent thrombosis when compared with
sirolimus eluting
stent (RR, 0.38; 95% CrI, 0.21-0.74),
paclitaxel eluting
stent (RR, 0.39; 95% CrI, 0.21-0.73), and even BMS (RR, 0.42; 95% CrI, 0.23-0.76). There was a 74% probability that EES had the lowest rate of any
stent thrombosis when compared with all other
stent types (no data on
zotarolimus-eluting
stent resolute). There was no increase in very late
stent thrombosis with EES versus BMS (RR, 0.89; 95% CrI, 0.09-8.67).
CONCLUSIONS: