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Efficacy and Safety of Stents in ST-Segment Elevation Myocardial Infarction
Ply Chichareon1, Rodrigo Modolo2, Carlos Collet3
1Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand. Electronic address: https://twitter.com/chichareon.
Insights
Drug-eluting stents (DES) are more effective than bare-metal stents (BMS) for ST-segment elevation myocardial infarction (STEMI) patients. Second-generation DES also reduce stent thrombosis compared to first-generation DES.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomaterials Science
Background:
- No single drug-eluting stent (DES) has demonstrated clear superiority over others in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI).
- Comparative effectiveness research is crucial for optimizing treatment strategies in STEMI management.
Purpose of the Study:
- To conduct a patient-level network meta-analysis comparing the safety and efficacy of various coronary artery stents in STEMI patients.
- To evaluate long-term clinical outcomes associated with different stent types.
Main Methods:
- Systematic review and patient-level network meta-analysis of dedicated randomized controlled trials (RCTs) in STEMI patients.
- Inclusion of 15 RCTs with individual patient data from 10,979 patients, representing a substantial portion of the evidence network.
- Primary endpoint: composite of cardiac death, reinfarction, or target lesion revascularization, with a minimum 12-month clinical follow-up.
Main Results:
- Drug-eluting stents (paclitaxel-, sirolimus-, everolimus-, biolimus-eluting) showed significantly lower risk of the primary endpoint compared to bare-metal stents (BMS).
- No significant differences in long-term efficacy or safety were found among different types of DES.
- Second-generation DES demonstrated a significantly lower risk of stent thrombosis compared to both BMS and first-generation DES.
Conclusions:
- Drug-eluting stents (DES) offer superior long-term efficacy compared to bare-metal stents (BMS) in STEMI patients.
- No significant differences in efficacy or safety exist among specific DES types.
- Second-generation DES are more effective than first-generation DES in reducing stent thrombosis.
Background:
To date, no specific drug-eluting stent (DES) has fully proven its superiority over others in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention.
Objectives:
The purpose of this study was to compare the safety and efficacy of coronary artery stents in STEMI patients in a patient-level network meta-analysis.
Methods:
Eligible studies were dedicated randomized controlled trials comparing different stents in STEMI patients undergoing percutaneous coronary intervention with at least 12 months of clinical follow-up. Of 19 studies identified from the published data, individual patient data were collected in 15 studies with 10,979 patients representing 87.7% of patients in the overall network of evidence. The primary endpoint was the composite of cardiac death, reinfarction, or target lesion revascularization.
Results:
Overall, 8,487 (77.3%) of 10,979 STEMI patients were male and the mean age was 60.7 years. At a median follow-up of 3 years, compared with bare-metal stents (BMS), patients treated with paclitaxel-, sirolimus-, everolimus-, or biolimus-eluting stents had a significantly lower risk of the primary endpoint (adjusted hazard ratios [HRs]: 0.74 [95% confidence interval (CI): 0.63 to 0.88], 0.65 [95% CI: 0.49 to 0.85], 0.70 [95% CI: 0.53 to 0.91], and 0.66 [95% CI: 0.49 to 0.88], respectively). The risk of primary endpoint was not different between patients treated with BMS and zotarolimus-eluting stents (adjusted HR: 0.83 [95% CI: 0.51 to 1.38]). Among patients treated with DES, no significant difference in the risk of the primary outcome was demonstrated. Treatment with second-generation DES was associated with significantly lower risk of definite or probable stent thrombosis compared with BMS (adjusted HR: 0.61 [95% CI: 0.42 to 0.89]) and first-generation DES (adjusted HR: 0.56 [95% CI: 0.36 to 0.88]).
Conclusions:
In STEMI patients, DES were superior to BMS with respect to long-term efficacy. No difference in long-term efficacy and safety was observed among specific DES. Second-generation were superior to first-generation DES in reducing stent thrombosis. (Clinical Outcomes After Primary Percutaneous Coronary Intervention [PCI] Using Contemporary Drug-Eluting Stent [DES]: Evidence From the Individual Patient Data Network Meta-Analysis; CRD42018104053).
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