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Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction: evidence from a comprehensive network meta-analysis.
J Am Coll Cardiol. 2013 Aug 06; 62(6):496-504.JACC

Abstract

OBJECTIVES

The authors investigated the relative safety and efficacy of different drug-eluting stents (DES) and bare metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI) using a network meta-analysis.

BACKGROUND

The relative safety of DES and BMS in patients with STEMI continues to be debated, and whether advances have been made in this regard with second-generation DES is unknown.

METHODS

Randomized controlled trials comparing currently U.S. approved DES or DES with BMS in patients with STEMI were searched using MEDLINE, EMBASE, and Cochrane databases. Information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted.

RESULTS

Twenty-two trials including 12,453 randomized patients were analyzed. At 1-year follow-up, cobalt-chromium everolimus eluting stents (CoCr-EES) were associated with significantly lower rates of cardiac death or myocardial infarction (MI) and stent thrombosis (ST) than BMS. Differences in ST were apparent as early as 30 days and were maintained for 2 years. CoCr-EES were also associated with significantly lower rates of 1-year ST than paclitaxel-eluting stents (PES). Sirolimus-eluting stents (SES) were also associated with significantly lower rates of 1-year cardiac death/myocardial infarction than BMS. CoCr-EES, PES, and SES, but not zotarolimus-eluting stents, had significantly lower rates of 1-year target vessel revascularization (TVR) than BMS, with SES also showing lower rates of TVR than PES.

CONCLUSIONS

In patients with STEMI, steady improvements in outcomes have been realized with the evolution from BMS to first-generation and now second-generation DES, with the most favorable safety and efficacy profile thus far demonstrated with CoCr-EES.

Authors+Show Affiliations

Dipartimento Cardiovascolare, Policlinico Sant' Orsola, Bologna, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

23747778

Citation

Palmerini, Tullio, et al. "Clinical Outcomes With Drug-eluting and Bare-metal Stents in Patients With ST-segment Elevation Myocardial Infarction: Evidence From a Comprehensive Network Meta-analysis." Journal of the American College of Cardiology, vol. 62, no. 6, 2013, pp. 496-504.
Palmerini T, Biondi-Zoccai G, Della Riva D, et al. Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction: evidence from a comprehensive network meta-analysis. J Am Coll Cardiol. 2013;62(6):496-504.
Palmerini, T., Biondi-Zoccai, G., Della Riva, D., Mariani, A., Sabaté, M., Valgimigli, M., Frati, G., Kedhi, E., Smits, P. C., Kaiser, C., Genereux, P., Galatius, S., Kirtane, A. J., & Stone, G. W. (2013). Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction: evidence from a comprehensive network meta-analysis. Journal of the American College of Cardiology, 62(6), 496-504. https://doi.org/10.1016/j.jacc.2013.05.022
Palmerini T, et al. Clinical Outcomes With Drug-eluting and Bare-metal Stents in Patients With ST-segment Elevation Myocardial Infarction: Evidence From a Comprehensive Network Meta-analysis. J Am Coll Cardiol. 2013 Aug 6;62(6):496-504. PubMed PMID: 23747778.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction: evidence from a comprehensive network meta-analysis. AU - Palmerini,Tullio, AU - Biondi-Zoccai,Giuseppe, AU - Della Riva,Diego, AU - Mariani,Andrea, AU - Sabaté,Manel, AU - Valgimigli,Marco, AU - Frati,Giacomo, AU - Kedhi,Elvin, AU - Smits,Pieter C, AU - Kaiser,Christoph, AU - Genereux,Philippe, AU - Galatius,Soren, AU - Kirtane,Ajay J, AU - Stone,Gregg W, Y1 - 2013/06/07/ PY - 2013/02/28/received PY - 2013/04/12/revised PY - 2013/05/14/accepted PY - 2013/6/11/entrez PY - 2013/6/12/pubmed PY - 2013/11/1/medline KW - BMS KW - CoCr-EES KW - DES KW - PC-ZES KW - PCI KW - PES KW - PRISMA KW - Preferred Reporting Items for Systematic Reviews and Meta-analyses KW - RCT KW - SES KW - ST-segment elevation acute myocardial infarction KW - STEMI KW - StThr KW - TVR KW - bare-metal stent(s) KW - cobalt-chromium everolimus-eluting stent(s) KW - drug-eluting stent(s) KW - meta-analysis KW - paclitaxel-eluting stent(s) KW - percutaneous coronary intervention KW - phosphorylcholine-based zotarolimus-eluting stent(s) KW - randomized controlled trial KW - sirolimus-eluting stent(s) KW - stent thrombosis KW - target vessel revascularizations SP - 496 EP - 504 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 62 IS - 6 N2 - OBJECTIVES: The authors investigated the relative safety and efficacy of different drug-eluting stents (DES) and bare metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI) using a network meta-analysis. BACKGROUND: The relative safety of DES and BMS in patients with STEMI continues to be debated, and whether advances have been made in this regard with second-generation DES is unknown. METHODS: Randomized controlled trials comparing currently U.S. approved DES or DES with BMS in patients with STEMI were searched using MEDLINE, EMBASE, and Cochrane databases. Information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted. RESULTS: Twenty-two trials including 12,453 randomized patients were analyzed. At 1-year follow-up, cobalt-chromium everolimus eluting stents (CoCr-EES) were associated with significantly lower rates of cardiac death or myocardial infarction (MI) and stent thrombosis (ST) than BMS. Differences in ST were apparent as early as 30 days and were maintained for 2 years. CoCr-EES were also associated with significantly lower rates of 1-year ST than paclitaxel-eluting stents (PES). Sirolimus-eluting stents (SES) were also associated with significantly lower rates of 1-year cardiac death/myocardial infarction than BMS. CoCr-EES, PES, and SES, but not zotarolimus-eluting stents, had significantly lower rates of 1-year target vessel revascularization (TVR) than BMS, with SES also showing lower rates of TVR than PES. CONCLUSIONS: In patients with STEMI, steady improvements in outcomes have been realized with the evolution from BMS to first-generation and now second-generation DES, with the most favorable safety and efficacy profile thus far demonstrated with CoCr-EES. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/23747778/Clinical_outcomes_with_drug_eluting_and_bare_metal_stents_in_patients_with_ST_segment_elevation_myocardial_infarction:_evidence_from_a_comprehensive_network_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(13)02161-X DB - PRIME DP - Unbound Medicine ER -