Journal article
Efficacy and Safety of Stents in ST-Segment Elevation Myocardial Infarction.
- Chichareon P Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand. Electronic address: https://twitter.com/chichareon.
- Modolo R Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP), Campinas, Brazil. Electronic address: https://twitter.com/R_Modolo.
- Collet C Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
- Tenekecioglu E Erasmus Medical Center, Rotterdam, the Netherlands.
- Vink MA OLVG Hospital, Amsterdam, the Netherlands.
- Oh PC Department of Cardiology, Gachon University Gil Medical Center, Incheon, South Korea.
- Ahn JM Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
- Musto C Interventional Cardiology Unit-San Camillo Hospital, Rome, Italy.
- Díaz de la Llera LS Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Virgen del Rocío, Seville, Spain.
- Cho YS Seoul National University Bundang Hospital, Seongnam, South Korea.
- Violini R Interventional Cardiology Unit-San Camillo Hospital, Rome, Italy.
- Park SJ Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
- Suryapranata H Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
- Piek JJ Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
- de Winter RJ Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
- Wykrzykowska JJ Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
- Spaulding C Cardiology Department, European Hospital Georges Pompidou-Assistance Publique Hôpitaux de Paris, Sudden Death Expert Center, INSERM U 970, PARCC, Paris Descartes University, Paris, France.
- Kang WC Department of Cardiology, Gachon University Gil Medical Center, Incheon, South Korea.
- Slagboom T OLVG Hospital, Amsterdam, the Netherlands.
- Hofma SH Medisch Centrum Leeuwarden, Leeuwarden, the Netherlands.
- Wijnbergen IF Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.
- Di Lorenzo E Cardiology Department, G. Moscati Hospital, Avellino, Italy.
- Pijls NH Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.
- Räber L Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Brugaletta S Hospital Clinic, Institut Clinic Cardiovascular, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
- Sabaté M Hospital Clinic, Institut Clinic Cardiovascular, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
- Stoll HP Biosensors Clinical Research, Morges, Switzerland.
- Stone GW New York Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York.
- Windecker S Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Onuma Y Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Cardialysis Clinical Trials Management and Core Laboratories, Rotterdam, the Netherlands. Electronic address: yoshinobuonuma@gmail.com.
- Serruys PW Department of Cardiology, Imperial College of London, London, United Kingdom. Electronic address: patrick.w.j.c.serruys@gmail.com.
- 2019-11-23
Published in:
- Journal of the American College of Cardiology. - 2019
ST-segment elevation myocardial infarction
bare-metal stents
drug-eluting stents
efficacy
individual patient data network meta-analysis
safety
Drug-Eluting Stents
Humans
Percutaneous Coronary Intervention
Randomized Controlled Trials as Topic
ST Elevation Myocardial Infarction
Treatment Outcome
English
BACKGROUND
To date, no specific drug-eluting stent (DES) has fully proven its superiority over others in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention.
OBJECTIVES
The purpose of this study was to compare the safety and efficacy of coronary artery stents in STEMI patients in a patient-level network meta-analysis.
METHODS
Eligible studies were dedicated randomized controlled trials comparing different stents in STEMI patients undergoing percutaneous coronary intervention with at least 12 months of clinical follow-up. Of 19 studies identified from the published data, individual patient data were collected in 15 studies with 10,979 patients representing 87.7% of patients in the overall network of evidence. The primary endpoint was the composite of cardiac death, reinfarction, or target lesion revascularization.
RESULTS
Overall, 8,487 (77.3%) of 10,979 STEMI patients were male and the mean age was 60.7 years. At a median follow-up of 3 years, compared with bare-metal stents (BMS), patients treated with paclitaxel-, sirolimus-, everolimus-, or biolimus-eluting stents had a significantly lower risk of the primary endpoint (adjusted hazard ratios [HRs]: 0.74 [95% confidence interval (CI): 0.63 to 0.88], 0.65 [95% CI: 0.49 to 0.85], 0.70 [95% CI: 0.53 to 0.91], and 0.66 [95% CI: 0.49 to 0.88], respectively). The risk of primary endpoint was not different between patients treated with BMS and zotarolimus-eluting stents (adjusted HR: 0.83 [95% CI: 0.51 to 1.38]). Among patients treated with DES, no significant difference in the risk of the primary outcome was demonstrated. Treatment with second-generation DES was associated with significantly lower risk of definite or probable stent thrombosis compared with BMS (adjusted HR: 0.61 [95% CI: 0.42 to 0.89]) and first-generation DES (adjusted HR: 0.56 [95% CI: 0.36 to 0.88]).
CONCLUSIONS
In STEMI patients, DES were superior to BMS with respect to long-term efficacy. No difference in long-term efficacy and safety was observed among specific DES. Second-generation were superior to first-generation DES in reducing stent thrombosis. (Clinical Outcomes After Primary Percutaneous Coronary Intervention [PCI] Using Contemporary Drug-Eluting Stent [DES]: Evidence From the Individual Patient Data Network Meta-Analysis; CRD42018104053).
To date, no specific drug-eluting stent (DES) has fully proven its superiority over others in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention.
OBJECTIVES
The purpose of this study was to compare the safety and efficacy of coronary artery stents in STEMI patients in a patient-level network meta-analysis.
METHODS
Eligible studies were dedicated randomized controlled trials comparing different stents in STEMI patients undergoing percutaneous coronary intervention with at least 12 months of clinical follow-up. Of 19 studies identified from the published data, individual patient data were collected in 15 studies with 10,979 patients representing 87.7% of patients in the overall network of evidence. The primary endpoint was the composite of cardiac death, reinfarction, or target lesion revascularization.
RESULTS
Overall, 8,487 (77.3%) of 10,979 STEMI patients were male and the mean age was 60.7 years. At a median follow-up of 3 years, compared with bare-metal stents (BMS), patients treated with paclitaxel-, sirolimus-, everolimus-, or biolimus-eluting stents had a significantly lower risk of the primary endpoint (adjusted hazard ratios [HRs]: 0.74 [95% confidence interval (CI): 0.63 to 0.88], 0.65 [95% CI: 0.49 to 0.85], 0.70 [95% CI: 0.53 to 0.91], and 0.66 [95% CI: 0.49 to 0.88], respectively). The risk of primary endpoint was not different between patients treated with BMS and zotarolimus-eluting stents (adjusted HR: 0.83 [95% CI: 0.51 to 1.38]). Among patients treated with DES, no significant difference in the risk of the primary outcome was demonstrated. Treatment with second-generation DES was associated with significantly lower risk of definite or probable stent thrombosis compared with BMS (adjusted HR: 0.61 [95% CI: 0.42 to 0.89]) and first-generation DES (adjusted HR: 0.56 [95% CI: 0.36 to 0.88]).
CONCLUSIONS
In STEMI patients, DES were superior to BMS with respect to long-term efficacy. No difference in long-term efficacy and safety was observed among specific DES. Second-generation were superior to first-generation DES in reducing stent thrombosis. (Clinical Outcomes After Primary Percutaneous Coronary Intervention [PCI] Using Contemporary Drug-Eluting Stent [DES]: Evidence From the Individual Patient Data Network Meta-Analysis; CRD42018104053).
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.jacc.2019.09.038
- PMID 31753202
- Persistent URL
- https://sonar.ch/global/documents/185315
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