Ply Chichareon1, Rodrigo Modolo2, Carlos Collet3, Erhan Tenekecioglu4, Maarten A Vink5, Pyung Chun Oh6, Jung-Min Ahn7, Carmine Musto8, Luis S Díaz de la Llera9, Young-Seok Cho10, Roberto Violini8, Seung-Jung Park7, Harry Suryapranata11, Jan J Piek12, Robbert J de Winter12, Joanna J Wykrzykowska12, Christian Spaulding13, Woong Chol Kang6, Ton Slagboom5, Sjoerd H Hofma14, Inge F Wijnbergen15, Emilio Di Lorenzo16, Nico H Pijls15, Lorenz Räber17, Salvatore Brugaletta18, Manel Sabaté18, Hans-Peter Stoll19, Gregg W Stone20, Stephan Windecker17, Yoshinobu Onuma21, Patrick W Serruys22. 1. Heart 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. 2. Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP), Campinas, Brazil. Electronic address: https://twitter.com/R_Modolo. 3. Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium. 4. Erasmus Medical Center, Rotterdam, the Netherlands. 5. OLVG Hospital, Amsterdam, the Netherlands. 6. Department of Cardiology, Gachon University Gil Medical Center, Incheon, South Korea. 7. Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. 8. Interventional Cardiology Unit-San Camillo Hospital, Rome, Italy. 9. Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Virgen del Rocío, Seville, Spain. 10. Seoul National University Bundang Hospital, Seongnam, South Korea. 11. Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands. 12. Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. 13. Cardiology Department, European Hospital Georges Pompidou-Assistance Publique Hôpitaux de Paris, Sudden Death Expert Center, INSERM U 970, PARCC, Paris Descartes University, Paris, France. 14. Medisch Centrum Leeuwarden, Leeuwarden, the Netherlands. 15. Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands. 16. Cardiology Department, G. Moscati Hospital, Avellino, Italy. 17. Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 18. Hospital Clinic, Institut Clinic Cardiovascular, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain. 19. Biosensors Clinical Research, Morges, Switzerland. 20. New York Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York. 21. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Cardialysis Clinical Trials Management and Core Laboratories, Rotterdam, the Netherlands. Electronic address: yoshinobuonuma@gmail.com. 22. Department of Cardiology, Imperial College of London, London, United Kingdom. Electronic address: patrick.w.j.c.serruys@gmail.com.
Abstract
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).
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).