Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction: Evidence from a comprehensive network meta-analysis

Tullio Palmerini, Giuseppe Biondi-Zoccai, Diego Della Riva, Andrea Mariani, Manel Sabaté, Marco Valgimigli, Giacomo Frati, Elvin Kedhi, Pieter C. Smits, Christoph Kaiser, Philippe Genereux, Soren Galatius, Ajay J. Kirtane, Gregg W. Stone

Research output: Contribution to journalArticle

143 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)496-504
Number of pages9
JournalJournal of the American College of Cardiology
Volume62
Issue number6
DOIs
StatePublished - Aug 6 2013
Externally publishedYes

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Stents
Thrombosis
Metals
Myocardial Infarction
Pharmaceutical Preparations
Drug-Eluting Stents
Chromium
Cobalt
Network Meta-Analysis
Sirolimus
Paclitaxel
Safety

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Palmerini, Tullio ; Biondi-Zoccai, Giuseppe ; Della Riva, Diego ; Mariani, Andrea ; Sabaté, Manel ; Valgimigli, Marco ; Frati, Giacomo ; Kedhi, Elvin ; Smits, Pieter C. ; Kaiser, Christoph ; Genereux, Philippe ; Galatius, Soren ; Kirtane, Ajay J. ; Stone, Gregg W. / Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction : Evidence from a comprehensive network meta-analysis. In: Journal of the American College of Cardiology. 2013 ; Vol. 62, No. 6. pp. 496-504.
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title = "Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction: Evidence from a comprehensive network meta-analysis",
abstract = "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.",
author = "Tullio Palmerini and Giuseppe Biondi-Zoccai and {Della Riva}, Diego and Andrea Mariani and Manel Sabat{\'e} and Marco Valgimigli and Giacomo Frati and Elvin Kedhi and Smits, {Pieter C.} and Christoph Kaiser and Philippe Genereux and Soren Galatius and Kirtane, {Ajay J.} and Stone, {Gregg W.}",
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Palmerini, T, Biondi-Zoccai, G, Della Riva, D, Mariani, A, Sabaté, M, Valgimigli, M, Frati, G, Kedhi, E, Smits, PC, Kaiser, C, Genereux, P, Galatius, S, Kirtane, AJ & Stone, GW 2013, 'Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction: Evidence from a comprehensive network meta-analysis', Journal of the American College of Cardiology, vol. 62, no. 6, pp. 496-504. https://doi.org/10.1016/j.jacc.2013.05.022

Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction : Evidence from a comprehensive network meta-analysis. / Palmerini, Tullio; Biondi-Zoccai, Giuseppe; Della Riva, Diego; Mariani, Andrea; Sabaté, Manel; Valgimigli, Marco; Frati, Giacomo; Kedhi, Elvin; Smits, Pieter C.; Kaiser, Christoph; Genereux, Philippe; Galatius, Soren; Kirtane, Ajay J.; Stone, Gregg W.

In: Journal of the American College of Cardiology, Vol. 62, No. 6, 06.08.2013, p. 496-504.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction

T2 - Evidence from a comprehensive network meta-analysis

AU - Palmerini, Tullio

AU - Biondi-Zoccai, Giuseppe

AU - Della Riva, Diego

AU - Mariani, Andrea

AU - Sabaté, Manel

AU - Valgimigli, Marco

AU - Frati, Giacomo

AU - Kedhi, Elvin

AU - Smits, Pieter C.

AU - Kaiser, Christoph

AU - Genereux, Philippe

AU - Galatius, Soren

AU - Kirtane, Ajay J.

AU - Stone, Gregg W.

PY - 2013/8/6

Y1 - 2013/8/6

N2 - 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.

AB - 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.

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