Comparison of Newer-Generation Drug-Eluting With Bare-Metal Stents in Patients With Acute ST-Segment Elevation Myocardial Infarction

• Published in: JACC. Cardiovascular interventions Vol. 7; no. 1; pp. 55 - 63
• Main Authors: Sabaté, Manel, Räber, Lorenz, Heg, Dik, Brugaletta, Salvatore, Kelbaek, Henning, Cequier, Angel, Ostojic, Miodrag, Iñiguez, Andrés, Tüller, David, Serra, Antonio, Baumbach, Andreas, von Birgelen, Clemens, Hernandez-Antolin, Rosana, Roffi, Marco, Mainar, Vicente, Valgimigli, Marco, Serruys, Patrick W., Jüni, Peter, Windecker, Stephan
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.01.2014
• Subjects: Cardiovascular; drug-eluting stent(s); STEMI; stent thrombosis; RR; BES; EES; DES; POCE; stent thrombosis; CI; STEMI; BMS; HR; DOCE; drug-eluting stent(s); everolimus-eluting stent(s); bare-metal stent(s); patient-oriented composite endpoint; biolimus A9–eluting stent(s); relative risk; device-oriented composite endpoint; hazard ratio; confidence interval; ST-segment elevation myocardial infarction
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2013.07.012

This study sought to study the efficacy and safety of newer-generation drug-eluting stents (DES) compared with bare-metal stents (BMS) in an appropriately powered population of patients with ST-segment elevation myocardial infarction (STEMI). Among patients with STEMI, early generation DES improved efficacy but not safety compared with BMS. Newer-generation DES, everolimus-eluting stents, and biolimus A9-eluting stents, have been shown to improve clinical outcomes compared with early generation DES. Individual patient data for 2,665 STEMI patients enrolled in 2 large-scale randomized clinical trials comparing newer-generation DES with BMS were pooled: 1,326 patients received a newer-generation DES (everolimus-eluting stent or biolimus A9-eluting stent), whereas the remaining 1,329 patients received a BMS. Random-effects models were used to assess differences between the 2 groups for the device-oriented composite endpoint of cardiac death, target-vessel reinfarction, and target-lesion revascularization and the patient-oriented composite endpoint of all-cause death, any infarction, and any revascularization at 1 year. Newer-generation DES substantially reduce the risk of the device-oriented composite endpoint compared with BMS at 1 year (relative risk [RR]: 0.58; 95% confidence interval [CI]: 0.43 to 0.79; p = 0.0004). Similarly, the risk of the patient-oriented composite endpoint was lower with newer-generation DES than BMS (RR: 0.78; 95% CI: 0.63 to 0.96; p = 0.02). Differences in favor of newer-generation DES were driven by both a lower risk of repeat revascularization of the target lesion (RR: 0.33; 95% CI: 0.20 to 0.52; p < 0.0001) and a lower risk of target-vessel infarction (RR: 0.36; 95% CI: 0.14 to 0.92; p = 0.03). Newer-generation DES also reduced the risk of definite stent thrombosis (RR: 0.35; 95% CI: 0.16 to 0.75; p = 0.006) compared with BMS. Among patients with STEMI, newer-generation DES improve safety and efficacy compared with BMS throughout 1 year. It remains to be determined whether the differences in favor of newer-generation DES are sustained during long-term follow-up.