Clinical Outcomes With Drug-Eluting and Bare-Metal Stents in Patients With ST-Segment Elevation Myocardial Infarction Evidence From a Comprehensive Network Meta-Analysis

被引：163

作者：

Palmerini, Tullio ^{[1
]}

Biondi-Zoccai, Giuseppe ^{[2
]}

Della Riva, Diego ^{[1
]}

Mariani, Andrea ^{[1
]}

Sabate, Manel ^{[3
]}

Valgimigli, Marco ^{[4
]}

Frati, Giacomo ^{[2
]}

Kedhi, Elvin ^{[5
]}

Smits, Pieter C. ^{[5
]}

Kaiser, Christoph ^{[6
]}

Genereux, Philippe ^{[7
,8
]}

Galatius, Soren ^{[9
]}

Kirtane, Ajay J. ^{[7
,8
]}

Stone, Gregg W. ^{[7
,8
]}

机构：

[1] Policlin St Orsola, Dipartimento Cardiovasc, Bologna, Italy

[2] Univ Roma La Sapienza, Dept Med Surg Sci & Biotechnol, Latina, Italy

[3] Hosp Clin Barcelona, Barcelona, Spain

[4] Univ Ferrara, Inst Cardiol, I-44100 Ferrara, Italy

[5] Maasstad Ziekenhuis, Dept Cardiol, Rotterdam, Netherlands

[6] Univ Basel Hosp, CH-4031 Basel, Switzerland

[7] Columbia Univ, Med Ctr, New York Presbyterian Hosp, New York, NY 10022 USA

[8] Cardiovasc Res Fdn, New York, NY USA

[9] Gentofte Univ Hosp, Dept Cardiol, Copenhagen, Denmark

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2013年 / 62卷 / 06期

关键词：

bare-metal stent(s); drug-eluting stent(s); meta-analysis; stent thrombosis; FOLLOW-UP; ANGIOPLASTY; MULTICENTER; CLOPIDOGREL; THROMBOSIS; ABCIXIMAB;

D O I：

10.1016/j.jacc.2013.05.022

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The authors investigated the relative safety and efficacy of different drug-eluting stents (DES) and bare metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI) using a network meta-analysis. Background The relative safety of DES and BMS in patients with STEMI continues to be debated, and whether advances have been made in this regard with second-generation DES is unknown. Methods Randomized controlled trials comparing currently U. S. approved DES or DES with BMS in patients with STEMI were searched using MEDLINE, EMBASE, and Cochrane databases. Information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted. Results Twenty-two trials including 12,453 randomized patients were analyzed. At 1-year follow-up, cobalt-chromium everolimus eluting stents (CoCr-EES) were associated with significantly lower rates of cardiac death or myocardial infarction (MI) and stent thrombosis (ST) than BMS. Differences in ST were apparent as early as 30 days and were maintained for 2 years. CoCr-EES were also associated with significantly lower rates of 1-year ST than paclitaxel-eluting stents (PES). Sirolimus-eluting stents (SES) were also associated with significantly lower rates of 1-year cardiac death/myocardial infarction than BMS. CoCr-EES, PES, and SES, but not zotarolimus-eluting stents, had significantly lower rates of 1-year target vessel revascularization (TVR) than BMS, with SES also showing lower rates of TVR than PES. Conclusions In patients with STEMI, steady improvements in outcomes have been realized with the evolution from BMS to first-generation and now second-generation DES, with the most favorable safety and efficacy profile thus far demonstrated with CoCr-EES. (J Am Coll Cardiol 2013;62:496-504) (C) 2013 by the American College of Cardiology Foundation

引用

页码：496 / 504

页数：9

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