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Drug-eluting stents versus bare-metal stents in acute myocardial infarction: A systematic review and meta-analysis

Authors
 Hae Sun Suh  ;  Hyun Jin Song  ;  Ji Eun Choi  ;  Eun Jin Jang  ;  Hee Jeong Son  ;  Sang Moo Lee  ;  Jung-Sun Kim  ;  Donghoon Choi 
Citation
 INTERNATIONAL JOURNAL OF TECHNOLOGY ASSESSMENT IN HEALTH CARE, Vol.27(1) : 11-22, 2011 
Journal Title
INTERNATIONAL JOURNAL OF TECHNOLOGY ASSESSMENT IN HEALTH CARE
ISSN
 0266-4623 
Issue Date
2011
MeSH
Acute Disease ; Drug-Eluting Stents/standards* ; Humans ; Myocardial Infarction/mortality ; Myocardial Infarction/therapy* ; Randomized Controlled Trials as Topic ; Treatment Outcome
Keywords
Myocardial infarction ; Drug-eluting stents ; Systematic review ; Meta-analysis
Abstract
OBJECTIVES: Recent concerns have been raised for the safety after drug-eluting stents (DES) implantation compared with the use of bare-metal stents (BMS) in patients with ST-elevation acute myocardial infarction (STEMI). The objective of this study was to estimate the relative impact of DES versus BMS on mortality, myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis (ST) in STEMI patients by performing comprehensive meta-analyses of randomized controlled trials (RCTs) and observational studies.

METHODS: We performed an electronic search and manual search of studies presented through September 2009, without language restrictions. An approach of "using systematic reviews" was used. Two independent reviewers extracted prespecified data from each study. A random-effects model was used to combine trials and to perform stratified analyses based on study designs and the duration of follow-up.

RESULTS: Fourteen RCTs were identified (N = 7,654). Compared with BMS, DES significantly reduced TVR (risk ratio [RR], 0.48; 95 percent confidence interval [CI], 0.41-0.56) and MI (RR, 0.77; 95 percent CI, 0.61-0.97), without increasing mortality (RR, 0.88; 95 percent CI, 0.70-1.10) and ST (RR, 0.93; 95 percent CI, 0.72-1.21). Among 35 observational studies (N = 44,849), the use of DES was associated with a significant reduction in mortality (RR, 0.85; 95 percent CI, 0.79-0.91) and TVR (RR, 0.61; 95 percent CI, 0.48-0.77). MI and ST were significantly lower in the DES group within 1-year follow-up, but there were no differences within 2 years of follow-up. There was no evidence of statistical heterogeneity and publication bias.

CONCLUSIONS: These data in aggregate suggest that using DES in STEMI patients is safe and efficacious, but there are differences between RCT and observational data comparing DES and BMS.
Full Text
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7984657
DOI
10.1017/S0266462310001340
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/93329
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