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European Heart Journal Advance Access originally published online on September 27, 2007
European Heart Journal 2007 28(22):2706-2713; doi:10.1093/eurheartj/ehm402
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Meta-analysis of randomized trials on drug-eluting stents vs. bare-metal stents in patients with acute myocardial infarction

Adnan Kastrati1,*, Alban Dibra1, Christian Spaulding2, Gerrit J. Laarman3, Maurizio Menichelli4, Marco Valgimigli5, Emilio Di Lorenzo6, Christoph Kaiser7, Ilkka Tierala8, Julinda Mehilli1, Melchior Seyfarth1, Olivier Varenne2, Maurits T. Dirksen3, Gianfranco Percoco5, Attilio Varricchio6, Undine Pittl7, Mikko Syvänne8, Maarten J. Suttorp9, Roberto Violini4 and Albert Schömig1

1 Deutsches Herzzentrum, Technische Universität, Lazarettstr.36, Munich 80636, Germany
2 Assistance Publique–Hôpitaux de Paris (AP–HP) Cochin Hospital, Paris 5 Medical School Rene Descartes University and INSERM U780-Avenir, Paris, France
3 Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
4 San Camillo Hospital, Rome, Italy
5 University of Ferrara, Ferrara, Italy
6 A.O.R.N. ‘S. G. Moscati’—Avellino, Italy
7 University of Basel, Basel, Switzerland
8 Helsinki University central Hospital, Helsinki, Finland
9 St. Antonius Hospital, Nieuwegein, The Netherlands

Received 28 May 2007; revised 25 July 2007; accepted 23 August 2007; online publish-ahead-of-print 27 September 2007.

* Corresponding author. Tel: +49 89 12184577; fax: +49 89 12184053. E-mail address: kastrati{at}dhm.mhn.de

See page 2693 for the editorial comment on this article (doi:10.1093/eurheartj/ehm474)

Aims: To compare the efficacy and safety of drug-eluting stents vs. bare-metal stents in patients with acute ST-segment elevation myocardial infarction.

Methods and results: We performed a meta-analysis of eight randomized trials comparing drug-eluting stents (sirolimus-eluting or paclitaxel-eluting stents) with bare-metal stents in 2786 patients with acute ST-segment elevation myocardial infarction. All patients were followed up for a mean of 12.0–24.2 months. Individual data were available for seven trials with 2476 patients. The primary efficacy endpoint was the need for reintervention (target lesion revascularization). The primary safety endpoint was stent thrombosis. Other outcomes of interest were death and recurrent myocardial infarction. Drug-eluting stents significantly reduced the risk of reintervention, hazard ratio of 0.38 (95% CI, 0.29–0.50), P < 0.001. The overall risk of stent thrombosis: hazard ratio of 0.80 (95% CI, 0.46–1.39), P = 0.43; death: hazard ratio of 0.76 (95% CI, 0.53–1.10), P = 0.14; and recurrent myocardial infarction: hazard ratio of 0.72 (95% CI, 0.48–1.08, P = 0.11) was not significantly different for patients receiving drug-eluting stents vs. bare-metal stents.

Conclusion: The use of drug-eluting stents in patients with acute ST-segment elevation myocardial infarction is safe and improves clinical outcomes by reducing the risk of reintervention compared with bare-metal stents.

Key Words: Acute myocardial infarction • Drug-eluting stents • Primary angioplasty • Restenosis • Stents • Thrombosis


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