Abstract 21035: Drug-Eluting Stents in ST Elevation Myocardial Infarction: An Updated Meta-Analysis
Background: Current guidelines recommend the use of drug-eluting stents (DES) as a reasonable alternative to bare-metal stent (BMS) for primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) in appropriate patients (Class IIa, level of evidence B recommendation).
Objectives: The primary aim of this study was to evaluate the latest evidence comparing DES with BMS for primary PCI in STEMI.
Methods: We performed a meta-analysis evaluating outcomes by stent type for death, myocardial infarction (MI), stent thrombosis, and target vessel revascularization (TVR) in randomized trials of STEMI published between 2005 and 2009. The pooled estimates for relative risk of outcomes were derived via a fixed-effects Mantel Haenszel model. Heterogeneity was assessed using the Cochran's Q and I2 tests. Numbers needed to treat (NNT) or harm (NNH) were derived as inverse of absolute risk difference (ARD).
Results: (Table): Fifteen randomized trials were identified (N = 8,492). Pooled data revealed that compared with BMS, DES significantly reduced TVR without increasing death, MI, or stent thrombosis. However, the absolute risk difference in TVR was approximately 6% (NNT =17), despite routine angiographic follow-up (which typically overestimates the TVR benefit by 2- to 3-fold) mandated by trial protocol. These observations were durable over 4 years.
Conclusions: The use of DES appears safe and efficacious in randomized trials of patients with STEMI. Although, these results allay the early concerns of stent thrombosis in the STEMI setting, the modest, albeit statistically significant, benefit in TVR coupled with the increased cost of DES and the attendant prolonged dual antiplatelet therapy argues against DES being the default choice for PCI in all patients with STEMI. A DES may be considered for clinical and anatomic settings in which the efficacy/safety/cost profile appears favorable.
- © 2010 by American Heart Association, Inc.