Abstract 4502: Drug-Eluting Stents Reduce Reinfarction Risk in Patients With Acute Myocardial Infarction: A Network Meta-Analysis
Background: The optimal stent choice for patients undergoing primary percutaneous coronary intervention (PCI) for acute ST-elevation myocardial infarction (STEMI) remains controversial. Several meta-analyses suggested a beneficial impact of DES over BMS with regard to target vessel revascularization (TVR). However, no benefit regarding other clinical endpoints was observed so far.
Methods: We searched medical databases and conference proceedings (2001 to May 7, 2009), for randomized controlled trials that compared DES with BMS or different DES in patients with STEMI. Random-effects models were used to calculate summary odds ratios (OR). An additional network meta-analysis was performed for indirect comparison of sirolimus-eluting stents (SES) versus paclitaxel-eluting stents (PES).
Results: A total of 15 trials enrolling 7,698 subjects were integrated in this analysis. Compared to BMS, DES use was associated with a significant decrease in 12 month-rate of re-infarction (OR 0.72 [0.55– 0.94]; p=0.015) as well as a general reduction in target-vessel revascularization (TVR; OR 0.42 [0.34 – 0.52]; p<0.001). The network meta-analysis showed lower benefit for PES compared to SES regarding TVR rate (OR 1.84 [1.16 –2.93]; p=0.016).
Conclusions: DES, when compared with BMS, was found to be associated with a 28% reduction in odds for re-infarction and a 58% reduction in odds for TVR in this updated analysis. Among DES, SES appear more effective than PES.