Lack of Clinical Benefit of Improved Angiographic Results With Sirolimus-Eluting Stents Compared With Paclitaxel and Zotarolimus-Eluting Stents in Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Choi, Cheol Ung; Rha, Seung Woon; Chen, Kang Yin; Li, Yong Jian; Poddar, Kanhaiya L.; Jin, Zhe; Minami, Yoshiyasu; Suh, Soon Yong; Na, Jin Oh; Lim, Hong Euy; Kim, Jin Won; Kim, Eung Ju; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo

doi:10.1253/circj.cj-08-1086

Cited by 10 publications

(6 citation statements)

References 29 publications

(26 reference statements)

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“…Korea Acute Myocardial Infarction Registry (KAMIR) study showed that the first-generation SES had the lower 1 year incidences of major adverse cardiac events (MACEs) and target lesion revascularization (TLR) than the second-generation ZES in patients with ST-segment elevation myocardial infarction undergoing primary PCI [9]. However, the benefit of the first-generation DES was not shown in an early small-scale study [10] and a randomized trial [11]. In contrast, the second-generation EES appeared to be associated with lower incidences of MACEs [12] and definite and/or probable stent thrombosis in patients with ST-segment elevation myocardial infarction [13].…”

Section: Introductionmentioning

confidence: 99%

Drug-Eluting Stents for Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials

Wang

Zang²,

Xie³

et al. 2013

PLoS ONE

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BackgroundDrug-eluting stents (DES) are increasingly used for treatment of acute coronary syndrome (ACS). However, clinical efficacy and safety of various types of DES is not well established in these subjects. We therefore evaluated clinical utility of second-generation and first-generation DES in patients with ACS by conducting a meta-analysis.MethodsA search of Medline, Embase, the Cochrane databases, and Web of Science was made. Randomized controlled trials (RCTs) which compared second-generation DES (everolimus-eluting stents [EES] or zotarolimus-eluting stents [ZES]) versus first-generation DES (sirolimus-eluting stents [SES] or paclitaxe-eluting stents [PES]) in patients with ACS and provided data on clinical efficacy or safety endpoints were included. Pooled estimates were calculated using random-effects model.ResultA total of 2,757 participants with ACS in 6 RCTs were included. Compared with first-generation one, second-generation DES trended to be associated with the decreased incidence of definite or probable stent thrombosis in ACS patients (risk ratio [RR] = 0.60, 95% confidence intervals [CI] 0.33 to 1.07, p = 0.09). However, the rate of target lesion revascularization (TLR) significantly increased in second-generation DES (RR = 2.08, 95%CI 1.25 to 3.47, p = 0.005). There were no significant differences in the incidence of major adverse cardiac events (MACEs), all-cause death, cardiac death, and recurrent myocardial infarction between the two arms (all p>0.10). The second-generation EES showed a tendency towards lower risk of MACEs (p = 0.06) and a beneficial effect on reducing stent thrombosis episodes (p = 0.009), while the second-generation ZES presented an increased occurrence of MACEs (p = 0.02) and TLR (p = 0.003).ConclusionSecond-generation DES, especially EES, appeared to present a lower risk of stent thrombosis, whereas second-generation ZES might increase the need for repeat revascularization in ACS patients. During coronary interventional therapy, DES class should be adequately considered in order to maximize clinical benefit of DES implantation in these specific subjects.

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Section: Introductionmentioning

confidence: 99%

Drug-Eluting Stents for Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials

Wang

Zang²,

Xie³

et al. 2013

PLoS ONE

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“…19 In the Massachusetts registry, the largest and the longest data to date, the incidence of ST was not presented. 20 Korean multicenter registry data also showed similar rates of ST. 22, 23 The ST data warrant a couple of discussion points. First, our data again shows the high rates of ST in the AMI setting, a factor which has been shown to be an independent predictor of ST after PCI.…”

Section: Discussionmentioning

confidence: 99%

Real World' Comparison of Drug-Eluting Stents vs Bare Metal Stents in the Treatment of Unselected Patients With Acute ST-Segment Elevation Myocardial Infarction

Park

Kang

Chung

et al. 2010

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp rug-eluting stents (DES) have significantly reduced the need for repeat revascularization procedures after percutaneous coronary intervention (PCI) owing to decreased late luminal loss and angiographic restenosis. 1,2 Since their introduction, DES have rapidly substituted bare metal stents (BMS) in the treatment of various coronary artery lesions, including the treatment of ST-segment elevation myocardial infarction (STEMI).Primary angioplasty with coronary stenting has become the standard treatment for STEMI; 3 however, long-term data on the efficacy and safety of DES in this clinical setting are still limited. Due to the increased incidence of very late stent thrombosis (ST) and the need for prolonged dual antiplatelet therapy (DAT) after DES use, 4-8 questions have recently been raised regarding the long-term efficacy and safety of DES in the treatment of patients with acute STEMI.A few randomized prospective clinical trials have compared the outcome of DES vs BMS in patients with STEMI, 9-15 where sirolimus-eluting stents (SES) showed a decrease in the need for target vessel revascularization (TVR) in a study that mandated angiographic follow up, while paclitaxel-eluting stents (PES) did not show a significant benefit in a study that did not mandate angiographic follow up. In these studies, the incidence of ST did not differ between DES and BMS. However, the populations studied in these trials were selected patients, which limited its generalization to 'real-world'

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“…As a matter of fact, among first generation DES, important differences can be found, generally in favor of sirolimus, 57-61 and also new generation DES performed better than older ones. 62, 63 Unfortunately, no stent type subgroup analysis was possible, as most of the collected papers do not report endpoints according to the type of DES implanted. However, if only sirolimus or new generation DES were used instead of paclitaxel DES, the good results observed in the DES population could probably be reinforced.…”

Section: Study Limitationsmentioning

confidence: 99%

Drug-Eluting Stents vs. Bare Metal Stents in Saphenous Vein Graft Disease - Insights From a Meta-Analysis of 7,090 Patients -

Lupi

Navarese

Lazzero

et al. 2011

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp rug-eluting stents (DES) are a major advance in interventional cardiology, but evidence in favor of their use in aortocoronary saphenous vein graft (SVG) disease, a common "off-label" indication for DES implantation in daily practice, is controversial. SVGs have a high occlusion rate 1,2 and percutaneous coronary intervention (PCI) with bare metal stent (BMS) implantation was the preferred treatment for SVG lesions 3-5 until the availability of DES, although the results were far from optimal. 4-7 DES are well known to be effective in reducing target vessel revascularization (TVR) in native vessels, 8-10 but concerns about a higher risk of late and very late stent thrombosis have been raised. 11 Nevertheless, the degeneration of SVG is quite a different phenomenon compared with progression of coronary artery atherosclerosis in native vessels. 12,13 Therefore, the outcome of DES in native coronary artery disease cannot be directly translated to this different clinical setting. 14 Previous nonrandomized studies as well as a few randomized controlled trials suggested that DES could substantially reduce the rate of re-intervention in SVG disease, 15-38 but reported data on mortality are conflicting 39 and biased by low statistical power. 14 Editorial p 261The aim of the present study was to perform a meta-analysis of both randomized and observational studies, comparing DES vs. BMS treatment in patients with SVG disease.

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Lack of Clinical Benefit of Improved Angiographic Results With Sirolimus-Eluting Stents Compared With Paclitaxel and Zotarolimus-Eluting Stents in Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Cited by 10 publications

References 29 publications

Drug-Eluting Stents for Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials

Drug-Eluting Stents for Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials

Real World' Comparison of Drug-Eluting Stents vs Bare Metal Stents in the Treatment of Unselected Patients With Acute ST-Segment Elevation Myocardial Infarction

Drug-Eluting Stents vs. Bare Metal Stents in Saphenous Vein Graft Disease - Insights From a Meta-Analysis of 7,090 Patients -

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