Drug-Eluting Stents for Treatment of Acute Myocardial Infarction
Drug-Eluting Stents for Treatment of Acute Myocardial Infarction
Background:Recent trials have shown the effects of drug-eluting stents (DES) in treatment of acute myocardial infarction (AMI), but data on the clinical outcome are still incomplete.
Methods: We performed a meta-analysis of all trials comparing DES and bare-metal stents (BMS) in AMI.
Results: We found 7 randomized trials comparing the effects of DES and BMS in AMI, enrolling a total of 2357 patients (1177 with DES and 1180 with BMS) with a follow-up of 8 to 12 months. Incidence of major cardiac events (death, myocardial infarction, or revascularization) was 9.3% in patients treated with DES and 17.6% in patients with BMS, with a relative risk (RR) of 0.53 with 95% CI 0.43 to 0.66. Incidence of death or myocardial infarction was similar in the two groups, occurring in 5.8% of patients with DES and 6.9% of patients treated with BMS, with an RR of 0.84 (95% CI 0.62-1.15). Target lesion revascularization occurred in 4.8% of DES and in 12.0% of BMS patients, with an RR of 0.40 (95% CI 0.30-0.54). Stent thrombosis occurred in 2.3% in DES versus 2.6% in BMS patients, with an RR of 0.87 (95% CI 0.53-1.45). There was no heterogeneity among trials in any of the analyses (I2 = 0% for all).
Conclusions: Drug-eluting stents significantly reduce need for revascularization in patients with AMI, without changes in incidence of death or myocardial infarction. Use of DES is not associated with an increased risk of stent thrombosis at 1-year follow-up.
Percutaneous coronary revascularization with stent implantation is the preferred strategy for treatment of acute myocardial infarction and is performed in increasing numbers of patients. Although use of stents has significantly reduced incidence of restenosis and repeated revascularization procedures compared with balloon angioplasty, resulting in better long term outcome, in-stent restenosis is still an important clinical problem. Studies on patients with acute myocardial infarction treated with bare-metal stents (BMS) have reported an incidence of repeated revascularization between 8% and 16%.
Drug-eluting stents (DES) have dramatically reduced the risk of restenosis after stent implantation, however, until recently, evidences on use of DES for treatment of acute myocardial infarction were limited. Although several registries have shown that DES can be safely used in acute myocardial infarction (AMI) and are associated with a significant decrease in risk of restenosis and of new revascularization procedures, a recent observational study in patients with AMI suggested that DES may be associated with an increased risk of cardiac events and mortality during a 6-month follow-up. Recently, several randomized controlled trials have been published or presented at international meetings; however, they enrolled a relatively limited number of patients. Thus, we performed a meta-analysis of all randomised trials on use of DES in AMI, with the aim to quantify the effect on reduction of target vessel revascularization and to assess possible risks associated with DES.
Abstract and Introduction
Abstract
Background:Recent trials have shown the effects of drug-eluting stents (DES) in treatment of acute myocardial infarction (AMI), but data on the clinical outcome are still incomplete.
Methods: We performed a meta-analysis of all trials comparing DES and bare-metal stents (BMS) in AMI.
Results: We found 7 randomized trials comparing the effects of DES and BMS in AMI, enrolling a total of 2357 patients (1177 with DES and 1180 with BMS) with a follow-up of 8 to 12 months. Incidence of major cardiac events (death, myocardial infarction, or revascularization) was 9.3% in patients treated with DES and 17.6% in patients with BMS, with a relative risk (RR) of 0.53 with 95% CI 0.43 to 0.66. Incidence of death or myocardial infarction was similar in the two groups, occurring in 5.8% of patients with DES and 6.9% of patients treated with BMS, with an RR of 0.84 (95% CI 0.62-1.15). Target lesion revascularization occurred in 4.8% of DES and in 12.0% of BMS patients, with an RR of 0.40 (95% CI 0.30-0.54). Stent thrombosis occurred in 2.3% in DES versus 2.6% in BMS patients, with an RR of 0.87 (95% CI 0.53-1.45). There was no heterogeneity among trials in any of the analyses (I2 = 0% for all).
Conclusions: Drug-eluting stents significantly reduce need for revascularization in patients with AMI, without changes in incidence of death or myocardial infarction. Use of DES is not associated with an increased risk of stent thrombosis at 1-year follow-up.
Introduction
Percutaneous coronary revascularization with stent implantation is the preferred strategy for treatment of acute myocardial infarction and is performed in increasing numbers of patients. Although use of stents has significantly reduced incidence of restenosis and repeated revascularization procedures compared with balloon angioplasty, resulting in better long term outcome, in-stent restenosis is still an important clinical problem. Studies on patients with acute myocardial infarction treated with bare-metal stents (BMS) have reported an incidence of repeated revascularization between 8% and 16%.
Drug-eluting stents (DES) have dramatically reduced the risk of restenosis after stent implantation, however, until recently, evidences on use of DES for treatment of acute myocardial infarction were limited. Although several registries have shown that DES can be safely used in acute myocardial infarction (AMI) and are associated with a significant decrease in risk of restenosis and of new revascularization procedures, a recent observational study in patients with AMI suggested that DES may be associated with an increased risk of cardiac events and mortality during a 6-month follow-up. Recently, several randomized controlled trials have been published or presented at international meetings; however, they enrolled a relatively limited number of patients. Thus, we performed a meta-analysis of all randomised trials on use of DES in AMI, with the aim to quantify the effect on reduction of target vessel revascularization and to assess possible risks associated with DES.
