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Drug-eluting stents in acute myocardial infarction: updated meta-analysis of randomized trials
Authors:Alban Dibra  Klaus Tiroch  Stefanie Schulz  Henning Kelbæk  Christian Spaulding  Gerrit J. Laarman  Marco Valgimigli  Emilio Di Lorenzo  Christoph Kaiser  Ilkka Tierala  Julinda Mehilli  Gianluca Campo  Leif Thuesen  Maarten A. Vink  Martin J. Schalij  Roberto Violini  Albert Schömig  Adnan Kastrati
Affiliation:1. Deutsches Herzzentrum, Technische Universit?t, Lazarettstr. 36, 80636, Munich, Germany
2. Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
3. Assistance Publique-H?pitaux de Paris (AP-HP), Cochin Hospital, Paris 5 Medical School Rene Descartes University and INSERM U780-Avenir, Paris, France
4. King’s College Hospital, London, UK
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. Skejby Sygehus, Skejby, Denmark
10. Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
11. Leiden University Medical Center, Leiden, The Netherlands
12. San Camillo Hospital, Rome, Italy
Abstract:

Background

Use of drug-eluting stents in patients with acute myocardial infarction (AMI) remains an “off label” indication due to concerns regarding their performance in this patient subset.

Methods

We searched Medline, the Cochrane Central Register of Controlled Trials, and Internet-based sources of information on clinical trials in cardiology for randomized trials comparing drug-eluting stents with bare-metal stents in patients with AMI. Hazard ratios for the composite of death or recurrent myocardial infarction, (primary safety endpoint), reintervention (primary efficacy endpoint), death, recurrent myocardial infarction, and stent thrombosis were calculated performing a meta-analysis of 14 randomized trials with 7,781 patients.

Results

There was no difference in the hazard of death or recurrent myocardial infarction (hazard ratio, 0.91; [95% CI 0.75–1.09]) between patients treated with drug-eluting stents versus patients treated with bare-metal stents. Treatment with drug-eluting stents resulted in a significant reduction in the hazard of reintervention (0.41 [95% CI 0.32–0.52]). The hazards of death (0.90 [95% CI 0.71–1.15]), myocardial infarction (0.81 [95% CI 0.63–1.04]), and stent thrombosis (0.84 [95% CI 0.61–1.17]) were not significantly different between patients treated with drug-eluting stents versus patients treated with bare-metal stents.

Conclusions

Use of drug-eluting stents in patients with AMI is safe and markedly reduces the need for reintervention as compared to bare-metal stents.
Keywords:
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