Meta-analysis of randomized trials on drug-eluting stents vs. bare-metal stents in patients with acute myocardial infarction

Abstract

The use of drug-eluting stents in patients with acute ST-segment elevation myocardial infarction is safe and improves clinical outcomes by reducing the risk of reintervention compared with bare-metal stents.

2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST‐Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update)

“…Three meta-analyses of these trials have concluded that there were no differences in death, MI, or stent thrombosis rates, but TVR rates were decreased with DES. [115][116][117] Variably included were 12 studies that differed in trial design, inclusion criteria, end-point definitions, stent types, duration of clopidogrel treatment, and type of followup (angiographic versus clinical). They were limited by sample size and duration of follow-up and by usually requiring angiographic documentation of stent thrombosis, which may have underestimated its true incidence.…”

Clinical outcomes in patients with ST-segment elevation myocardial infarction treated with everolimus-eluting stents versus bare-metal stents (EXAMINATION): 5-year results of a randomised trial

“…2 In this clinical setting, fi rst-generation drug-eluting stents (DES) reduced clinical and angiographic restenosis, compared with bare-metal stents (BMS). [3][4][5][6][7] Conversely, these benefi ts were counterbalanced by an increased risk of very late stent thrombosis, [8][9][10][11] safety concerns that were confi rmed on autopsy, and intravascular imaging studies showing evidence of incomplete endothelialisation, delayed arterial healing, and vessel remodelling because of chronic infl ammation. [12][13][14][15] The development of neotherosclerosis, 16 which might occur earlier after DES than after BMS, 17 has also been identifi ed as a potential cause.…”

Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents

“…12 In KAMIR data, DES use rate was N92% due to widely spread expected advantages of DESs among Korean physicians. Because of the stent thrombosis issues and the increased systemic thrombosis milieu in the early period of AMI patients, especially in STEMI patients undergoing primary PCI with DESs, proper Adjusted odds ratios for incidences of cardiac death (A), total death (B), and total MACE (C) associated with enoxaparin therapy in all study population and various subgroups of patients according to different stents, sex, and age.…”