Abstract 13080: Drug-Eluting Stents Versus Bare-Metal Stents in Primary Percutaneous Coronary Interventions is Efficacious And Safe for Long Term Outcomes in ST-Segment Elevation Myocardial Infarction. A Systematic Review and Meta-Analysis
Background: Use of drug-eluting stents (DES) in primary percutaneous coronary intervention (PPCI) reduces need for repeat revascularization compared to bare-metal stents (BMS). However, there are concerns about long-term efficacy and risk of late and very late stent thrombosis (ST) after DES use in PPCI. Individual trials may be underpowered to detect significant differences, particularly with paucity of ST events.
Hypothesis: We assessed the hypothesis that DES use reduces the need for revascularization in PPCI without a significant increase in adverse events at extended follow-up.
Methods: We searched for trials comparing BMS to DES in PPCI with reported outcomes after ≥3 years of follow-up. A total of 8 randomized controlled trials (RCTs) and 5 cohort studies matched the criteria for inclusion with a total of 10,477 participants. Meta-analysis was performed for each endpoint using random effects models.
Results: In RCTs (n=5797), patients receiving DES had a significantly lower risk of target lesion revascularization (TLR) (OR, 0.48; CI, 0.37 to 0.61) compared to BMS-treated patients. The incidence of ST was not different between the groups (OR; 1.03, CI: 0.77 to 1.38) and there was no difference in mortality or recurrent myocardial infarction (MI). Among cohort studies (n=4650), fewer studies reported on TLR; the trend favored DES. A small but statistically significant increase in ST was noted with DES use (OR; 1.62, CI: 1.18 to 2.21) (figure), but there was no evidence of increased mortality or recurrent MI.
Conclusion: In this meta-analysis of RCTs examining the long-term outcomes of stent type in primary PCI, DES use resulted in reduced TLR with no increase in ST, mortality or recurrent MI. However, cohort studies demonstrate a small increase in ST associated with DES use, but without increased risk of mortality or MI. The discrepancy is likely due to differences in patient and lesion characteristics, but is concerning and will need to be explored in future studies.
- © 2011 by American Heart Association, Inc.