Abstract 3439: Drug-Eluting Stents Reduce the Incidence of Myocardial Infarction in Comparison with Bare-Metal Stents During Follow-Up
Randomized studies and even previous meta-analysis have shown that the clinical benefit of drug-eluting stents (DES) is merely a reduction in the need for subsequent revascularization procedures, without affecting harder end-points (i.e. death or myocardial infarction, MI). As restenosis sometimes present as MI, and the treatment of in-stent restenosis may be complicated with peri-procedural MI, we hypothesized that DES reduce the incidence of MI in comparison with bare-metal stents (BMS).
Methods: We performed a meta-analysis from 25 randomized trials comparing commercially available DES in Europe with BMS. Overall, 9,791 patients were included (4,903 allocated to DES, and 4,888 to BMS), and clinical follow-up ranged from 6 to 12 months. Conventional meta-analytic techniques were used.
Results: there was no heterogeneity among the trials (Q-test: p=0.68). Out of the 9,791 patients included in all the trials, 364 suffered a MI. The risk of MI was significantly reduced in patients allocated to DES (3.3% vs. 4.2% in those allocated to BMS; P=0.04; OR 0.81; 95% CI: 0.65, 0.99) (see figure⇓). That means a relative risk reduction of 22% in the risk of MI (95% CI: 3%, 37%). In those trials in which the rate of Q-wave and non-Q-wave was provided, the incidence of Q-wave infarction was similar in patients allocated to DES and BMS (0.6% in both groups, P=0.77), but the risk of non-Q-wave myocardial infarction was lower (2.3% vs. 3.1%; P=0.07).
Conclusion: DES reduce the incidence of myocardial infarction during follow-up in comparison with BMS. These findings support the routine use of DES.