European Heart Journal

European Heart Journal Advance Access published online on September 27, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm402

This Article Full Text FREE Full Text (PDF) All Versions of this Article: 28/22/2706    most recent ehm402v1 E-letters: Submit a response Alert me when this article is cited Alert me when E-letters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Archive Download to citation manager Request Permissions Disclaimer Google Scholar Articles by Kastrati, A. Articles by Schömig, A. Search for Related Content PubMed PubMed Citation Articles by Kastrati, A. Articles by Schömig, A. Social Bookmarking          What's this?

© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

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

Adnan Kastrati^1,*, 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.

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

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

CiteULike    Connotea    Del.icio.us    What's this?

This article has been cited by other articles:

				F Zhang, L Dong, and J Ge Simple versus complex stenting strategy for coronary artery bifurcation lesions in the drug-eluting stent era: a meta-analysis of randomised trials Heart, October 15, 2009; 95(20): 1676 - 1681. [Abstract] [Full Text] [PDF]

				R. A. Byrne, A. Kastrati, S. Kufner, S. Massberg, K. A. Birkmeier, K.-L. Laugwitz, S. Schulz, J. Pache, M. Fusaro, M. Seyfarth, et al. Randomized, non-inferiority trial of three limus agent-eluting stents with different polymer coatings: the Intracoronary Stenting and Angiographic Results: Test Efficacy of 3 Limus-Eluting Stents (ISAR-TEST-4) Trial Eur. Heart J., October 2, 2009; 30(20): 2441 - 2449. [Abstract] [Full Text] [PDF]

				A. D. Kugelmass The quest for a 'better mousetrap' Eur. Heart J., October 2, 2009; 30(20): 2431 - 2432. [Full Text] [PDF]

				E. Di Lorenzo, R. Sauro, A. Varricchio, G. Carbone, G. Cortese, M. Capasso, T. Lanzillo, F. Manganelli, C. Mariello, F. Siano, et al. Long-Term Outcome of Drug-Eluting Stents Compared With Bare Metal Stents in ST-Segment Elevation Myocardial Infarction: Results of the Paclitaxel- or Sirolimus-Eluting Stent Versus Bare Metal Stent in Primary Angioplasty (PASEO) Randomized Trial Circulation, September 15, 2009; 120(11): 964 - 972. [Abstract] [Full Text] [PDF]

				A. V. Finn, G. Nakazawa, F. Kolodgie, and R. Virmani Drug eluting or bare metal stent for acute myocardial infarction: an issue of safety? Eur. Heart J., August 1, 2009; 30(15): 1828 - 1830. [Full Text] [PDF]

				C. Herdeg, K. Gohring-Frischholz, K. K. Haase, T. Geisler, C. Zurn, U. Hartmann, J. Wohrle, T. Nusser, J. Dippon, A. E. May, et al. Catheter-Based Delivery of Fluid Paclitaxel for Prevention of Restenosis in Native Coronary Artery Lesions After Stent Implantation Circ Cardiovasc Interv, August 1, 2009; 2(4): 294 - 301. [Abstract] [Full Text] [PDF]

				E. Di Lorenzo, G. De Luca, R. Sauro, A. Varricchio, M. Capasso, T. Lanzillo, F. Manganelli, C. Mariello, F. Siano, M. R. Pagliuca, et al. The PASEO (PaclitAxel or Sirolimus-Eluting Stent Versus Bare Metal Stent in Primary Angioplasty) Randomized Trial J. Am. Coll. Cardiol. Intv., June 1, 2009; 2(6): 515 - 523. [Abstract] [Full Text] [PDF]

				N. Kukreja, Y. Onuma, H. M. Garcia-Garcia, J. Daemen, R. van Domburg, P. W. Serruys, and on behalf of the Interventional cardiologists of t The Risk of Stent Thrombosis in Patients With Acute Coronary Syndromes Treated With Bare-Metal and Drug-Eluting Stents J. Am. Coll. Cardiol. Intv., June 1, 2009; 2(6): 534 - 541. [Abstract] [Full Text] [PDF]

				J. Mehilli, A. Kastrati, R. A. Byrne, O. Bruskina, R. Iijima, S. Schulz, J. Pache, M. Seyfarth, S. Massberg, K.-L. Laugwitz, et al. Paclitaxel- Versus Sirolimus-Eluting Stents for Unprotected Left Main Coronary Artery Disease J. Am. Coll. Cardiol., May 12, 2009; 53(19): 1760 - 1768. [Abstract] [Full Text] [PDF]

				S. K. James, U. Stenestrand, J. Lindback, J. Carlsson, F. Schersten, T. Nilsson, L. Wallentin, B. Lagerqvist, and the SCAAR Study Group Long-Term Safety and Efficacy of Drug-Eluting versus Bare-Metal Stents in Sweden N. Engl. J. Med., May 7, 2009; 360(19): 1933 - 1945. [Abstract] [Full Text] [PDF]

				S. S. Brar, M. B. Leon, G. W. Stone, R. Mehran, J. W. Moses, S. K. Brar, and G. Dangas Use of drug-eluting stents in acute myocardial infarction: a systematic review and meta-analysis. J. Am. Coll. Cardiol., May 5, 2009; 53(18): 1677 - 1689. [Abstract] [Full Text] [PDF]

				J. Carlsson, S. K. James, J. Lindback, F. Schersten, T. Nilsson, U. Stenestrand, B. Lagerqvist, and for the SCAAR (Swedish Coronary Angiography and An Outcome of Drug-Eluting Versus Bare-Metal Stenting Used According to On- and Off-Label Criteria J. Am. Coll. Cardiol., April 21, 2009; 53(16): 1389 - 1398. [Abstract] [Full Text] [PDF]

				J. R. Margolis The Excel Stent: A Good DES, But Can We Really Stop Clopidogrel After 6 Months? J. Am. Coll. Cardiol. Intv., April 1, 2009; 2(4): 310 - 311. [Full Text] [PDF]

				Ph. G. Steg, K. A.A. Fox, K. A. Eagle, M. Furman, F. Van de Werf, G. Montalescot, S. G. Goodman, A. Avezum, W. Huang, J. M. Gore, et al. Mortality following placement of drug-eluting and bare-metal stents for ST-segment elevation acute myocardial infarction in the Global Registry of Acute Coronary Events Eur. Heart J., February 1, 2009; 30(3): 321 - 329. [Abstract] [Full Text] [PDF]

				C. W. Hamm, H. Möllmann, J.-P. Bassand, and F. van de Werf CHAPTER 16 Acute Coronary Syndromes ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				L. O. Jensen, M. Maeng, P. Thayssen, A. Kaltoft, H. H. Tilsted, M. Bottcher, J. F. Lassen, K. N. Hansen, L. R. Krusell, K. Rasmussen, et al. Clinical Outcome After Primary Percutaneous Coronary Intervention With Drug-Eluting and Bare Metal Stents in Patients With ST-Segment Elevation Myocardial Infarction Circ Cardiovasc Interv, December 1, 2008; 1(3): 176 - 184. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, F. Van de Werf, J. Bax, A. Betriu, C. Blomstrom-Lundqvist, F. Crea, V. Falk, G. Filippatos, K. Fox, K. Huber, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology: Eur. Heart J., December 1, 2008; 29(23): 2909 - 2945. [Full Text] [PDF]

				E. R. Bates Primary Percutaneous Coronary Intervention With Drug-Eluting Stents: Another Chapter in the Stent Controversy Circ Cardiovasc Interv, October 1, 2008; 1(2): 87 - 89. [Full Text] [PDF]

				N. Kukreja, Y. Onuma, H. Garcia-Garcia, J. Daemen, R. van Domburg, and P. W. Serruys Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: Long-Term Outcome After Bare Metal and Drug-Eluting Stent Implantation Circ Cardiovasc Interv, October 1, 2008; 1(2): 103 - 110. [Abstract] [Full Text] [PDF]

				L. Mauri, T. S. Silbaugh, P. Garg, R. E. Wolf, K. Zelevinsky, A. Lovett, M. R. Varma, Z. Zhou, and S.-L. T. Normand Drug-Eluting or Bare-Metal Stents for Acute Myocardial Infarction N. Engl. J. Med., September 25, 2008; 359(13): 1330 - 1342. [Abstract] [Full Text] [PDF]

				M. E. Pfisterer Late Stent Thrombosis After Drug-Eluting Stent Implantation for Acute Myocardial Infarction: A New Red Flag Is Raised Circulation, September 9, 2008; 118(11): 1117 - 1119. [Full Text] [PDF]

				G. Nakazawa, A. V. Finn, M. Joner, E. Ladich, R. Kutys, E. K. Mont, H. K. Gold, A. P. Burke, F. D. Kolodgie, and R. Virmani Delayed Arterial Healing and Increased Late Stent Thrombosis at Culprit Sites After Drug-Eluting Stent Placement for Acute Myocardial Infarction Patients: An Autopsy Study Circulation, September 9, 2008; 118(11): 1138 - 1145. [Abstract] [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The year in interventional cardiology. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2355 - 2369. [Full Text] [PDF]

				M. H. Shishehbor, R. Amini, L. P.J. Oliveria, I. M. Singh, P. Kelly, D. L. Bhatt, S. R. Kapadia, S. G. Ellis, P. L. Whitlow, and S. J. Brener Comparison of Drug-Eluting Stents Versus Bare-Metal Stents for Treating ST-Segment Elevation Myocardial Infarction J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 227 - 232. [Abstract] [Full Text] [PDF]

				C. S. Rihal Drug-Eluting Stents for ST-Segment Elevation Myocardial Infarction: Treatment of Choice or Is Discretion the Better Part of Valor? J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 233 - 235. [Full Text] [PDF]

				C. L. Grines, J. A. Goldstein, and R. D. Safian Should We Routinely Use Drug-Eluting Stents for Acute Myocardial Infarction?: Let's Wait and See J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 136 - 138. [Full Text] [PDF]

				S. P. Marso Diabetes and Drug-Eluting Stents: What You Get and What You Don't J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 148 - 149. [Full Text] [PDF]

				C. L. Grines Off-label use of drug-eluting stents putting it in perspective. J. Am. Coll. Cardiol., February 12, 2008; 51(6): 615 - 617. [Full Text] [PDF]

				Bare-Metal or Drug-Eluting Stenting in Acute MI? Journal Watch Cardiology, January 23, 2008; 2008(123): 3 - 3. [Full Text]

				P. J. Vlaar, B. J. G. L. de Smet, and F. Zijlstra DES or BMS in acute myocardial infarction? Eur. Heart J., November 2, 2007; 28(22): 2693 - 2694. [Full Text] [PDF]

Online ISSN 1522-9645 - Print ISSN 0195-668x

Copyright © 2009 European Society of Cardiology

Oxford Journals Oxford University Press

• Site Map
• Privacy Policy
• Frequently Asked Questions

Other Oxford University Press sites: Oxford University Press Oxford Journals China Oxford Journals Japan American National Biography Booksellers' Information Service Children's Fiction and Poetry Children's Reference Corporate & Special Sales Dictionaries Dictionary of National Biography Digital Reference English Language Teaching Higher Education Textbooks Humanities International Education Unit Law Medicine Music Online Products Oxford English Dictionary Reference Rights and Permissions Science School Books Social Sciences Very Short Introductions World's Classics