Sirolimus-eluting stents reduce long-term mortality compared with bare metal stents in ST-segment elevation...

Sirolimus-eluting stents (SES) have demonstrated more favorable outcomes compared with bare metal stents (BMS) for ST-segment elevation myocardial infarction (STEMI) within medium term follow up in randomized controlled trials (RCT). However, long-term outcomes remain unknown.

We conducted a meta-analysis of RCT comparing SES with BMS in STEMI patients at long-term follow up, defined as 2 years or more after primary percutaneous coronary intervention (PCI). The clinical end points of our interest were death, recurrent myocardial infarction (MI), definite stent thrombosis (ST), and target lesion revascularization (TLR). We calculated the pooled estimate based on a fixed-effects model using Peto odds ratio (OR) for rare events. If heterogeneity was observed across an individual RCT, an analysis based on a random-effects model was performed.

Four RCT were included in this study, involving 1304 patients (656 patients randomized to SES and 648 patients to BMS). Up to 4 years, SES showed a significant reduction in not only TLR (OR: 0.44, 95% confidence interval (CI): 0.31 to 0.62, p<0.001) but also mortality (OR: 0.62, 95% CI: 0.39 to 1.00, p=0.049) compared with BMS. In contrast, the proportions of recurrent MI (OR: 0.82, 95% CI: 0.52 to 1.28, p=0.378) and definite ST (OR: 1.13, 95% CI: 0.56 to 2.27, p=0.740) were comparable between the 2 groups.

In this meta-analysis of long-term RCT, primary PCI for STEMI patients with SES was associated with a decrease in mortality as well as TLR without an increase in recurrent MI or definite ST compared with BMS.