Efficacy and Safety of Stents in ST-Segment Elevation Myocardial Infarction.

Chichareon, Ply; Modolo, Rodrigo; Collet, Carlos; Tenekecioglu, Erhan; Vink, Maarten A; Oh, Pyung Chun; Ahn, Jung-Min; Musto, Carmine; Díaz de la Llera, Luis S; Cho, Young-Seok; Violini, Roberto; Park, Seung-Jung; Suryapranata, Harry; Piek, Jan J; de Winter, Robbert J; Wykrzykowska, Joanna J; Spaulding, Christian; Kang, Woong Chol; Slagboom, Ton; Hofma, Sjoerd H; ... (2019). Efficacy and Safety of Stents in ST-Segment Elevation Myocardial Infarction. Journal of the American College of Cardiology, 74(21), pp. 2572-2584. Elsevier 10.1016/j.jacc.2019.09.038

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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).

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