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Review Article |

Drug-Eluting vs Bare-Metal Stents in Primary Angioplasty:  A Pooled Patient-Level Meta-analysis of Randomized Trials FREE

Giuseppe De Luca, MD, PhD; Maurits T. Dirksen, MD; Christian Spaulding, MD; Henning Kelbæk, MD; Martin Schalij, MD; Leif Thuesen, MD; Bas van der Hoeven, MD; Marteen A. Vink, MD; Christoph Kaiser, MD; Carmine Musto, MD; Tania Chechi, MD; Gaia Spaziani, MD; Luis Salvador Díaz de la Llera, MD; Vincenzo Pasceri, MD; Emilio Di Lorenzo, MD; Roberto Violini, MD; Giuliana Cortese, PhD; Harry Suryapranata, MD; Gregg W. Stone, MD; for the Drug-Eluting Stent in Primary Angioplasty (DESERT) Cooperation
[+] Author Affiliations

Author Affiliations: Division of Cardiology, Ospedale “Maggiore della Carità” and Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA) (Dr De Luca), Eastern Piedmont University, Novara, Italy; Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (Drs Dirksen and Vink); Cardiology Department European Hospital Georges Pompidou, Assistance Publique–Hôpitaux de Paris and INSERM U 970, Paris Descartes University, Paris, France (Dr Spaulding); The Heart Center, Rigshospitalet, Copenhagen, Denmark (Dr Kelbæk); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (Drs Schalij and van der Hoeven); Cardiac Department, Skejby Hospital, Skejby, Denmark (Dr Thuesen); Department of Cardiology, University Hospital Basel, Basel, Switzerland (Dr Kaiser); Division of Cardiology, San Camillo Hospital, Rome, Italy (Drs Musto and Violini); Ospedale Santa Maria Annunziata, Bagno a Ripoli, Florence, Italy (Drs Chechi and Spaziani); Hemodynamics and Interventional Cardiology Unit, University Hospital Virgen del Rocio, Seville, Spain (Dr Díaz de la Llera); Interventional Cardiology Unit, San Filippo Neri Hospital, Rome (Dr Pasceri); Division of Cardiology, “S. G. Moscati,” Avellino, Italy (Dr Di Lorenzo); Department of Biostatistics, University of Copenhagen, Copenhagen (Dr Cortese); Department of Cardiology, UMC St Radboud, Nijmegen, the Netherlands (Dr Suryapranata); and Columbia University Medical Center and the Cardiovascular Research Foundation, New York City, New York (Dr Stone).


Arch Intern Med. 2012;172(8):611-621. doi:10.1001/archinternmed.2012.758.
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Background Concerns have emerged regarding a higher risk of stent thrombosis after drug-eluting stent (DES) implantation, especially in the setting of ST-segment elevation myocardial infarction (STEMI). Our objective was to perform a meta-analysis using individual patient data to evaluate the long-term safety and effectiveness of DES compared with bare-metal stents (BMS) in patients undergoing primary percutaneous coronary intervention for STEMI.

Data Sources Formal searches of electronic databases (MEDLINE and CENTRAL) and scientific session presentations from January 2000 to June 2011.

Study Selection We examined all completed randomized trials of DES for STEMI.

Data Extraction Individual patient data.

Data Synthesis Individual patient data were obtained from 11 of 13 trials identified, including a total of 6298 patients (3980 [63.2%] randomized to DES [99% sirolimus-eluting or paclitaxel-eluting stents] and 2318 [36.8%] randomized to BMS). At long-term follow-up (mean [SD], 1201 [440] days), DES implantation significantly reduced the occurrence of target-vessel revascularization (12.7% vs 20.1%; hazard ratio [95% CI], 0.57 [0.50-0.66]; P < .001, P value for heterogeneity, .20), without any significant difference in terms of mortality, reinfarction, and stent thrombosis. However, DES implantation was associated with an increased risk of very late stent thrombosis and reinfarction.

Conclusions The present pooled patient-level meta-analysis demonstrates that among patients with STEMI undergoing primary percutaneous coronary intervention, sirolimus-eluting and paclitaxel-eluting stents compared with BMS are associated with a significant reduction in target-vessel revascularization at long-term follow-up. Although there were no differences in cumulative mortality, reinfarction, or stent thrombosis, the incidence of very late reinfarction and stent thrombosis was increased with these DES.

Figures in this Article

The early administration of pharmacological and/or mechanical reperfusion therapies1,2 and improvements in antiplatelet and anticoagulation agents36 have greatly contributed to the reduction in mortality achieved over the last 2 decades in patients with ST-segment elevation myocardial infarction (STEMI). In randomized trials, bare-metal stents (BMS) have been shown to reduce target-vessel revascularization (TVR) in STEMI, with rates of death and/or reinfarction comparable to balloon angioplasty.79 However, these benefits may not be as profound in unselected patients with STEMI.8

Drug-eluting stents (DES) have shown a further significant reduction in restenosis and TVR in patients without acute coronary syndromes compared with BMS.1014 Initial meta-analyses showed the efficacy and safety of DES at short-term follow-up in the setting of STEMI,1517 with no safety issues. However, concerns have emerged regarding a potentially higher risk of stent thrombosis (ST) with DES18,19 that might be even more pronounced among patients with STEMI, as suggested by a prospective registry.2022 Therefore, the aim of the Drug-Eluting Stents in Primary Angioplasty (DESERT) Cooperation was to perform a pooled patient-level meta-analysis of randomized trials to evaluate the risks and benefits of DES compared with BMS in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI.

ELIGIBILITY AND SEARCH STRATEGY

To identify all completed, randomized trials comparing DES vs BMS in primary PCI for STEMI, we scanned the literature by formal searches of electronic databases (MEDLINE and CENTRAL) and the scientific session abstracts in Circulation,Journal of College of Cardiology, European Heart Journal, and American Journal of Cardiology from January 2000 to June 2011. Furthermore, oral presentations and/or expert slide presentations were included (searched on the Transcatheter Cardiovascular Therapeutics (TCT) [ http://www.tctmd.com], EuroPCR [ http://www.europcr.com], American College of Cardiology (ACC) [ http://www.acc.org], American Hospital Association (AHA) [ http://www.aha.org], and European Society of Cardiology (ESC) [ http://www.escardio.org] websites from January 2000 to June 2011). The following keywords were used: randomized trial, myocardial infarction, reperfusion, primary angioplasty, stenting, DES, BMS, sirolimus-eluting stent (SES), Cypher (Cordis Corporation), paclitaxel-eluting stent (PES), Taxus (Boston Scientific Corporation). Inclusion criteria were (1) randomized treatment allocation, (2) follow-up data of more than 1 year, and (3) availability of complete clinical data. Exclusion criteria were (1) follow-up data in less than 90% of patients, (2) ongoing studies or irretrievable data, (3) trials with overall small sample size (<50 patients), and (4) investigators' unwillingness to provide individual patient data. No language restrictions were enforced. All principal investigators were contacted and invited to provide individual patient data, which were transferred without patient identifiers to the Eastern Piedmont University, Novara, Italy. The dataset was checked for completeness and consistency and compared with the results from any publications. Queries were resolved by direct correspondence with the responsible study investigator. Data were managed according to the intention-to-treat principle.

The primary end point for the present study was mortality, whereas secondary end points were reinfarction, TVR, and ST (definite or probable according to Academic Research Consortium [ARC] definitions) at long-term follow-up.

Statistical analysis was performed using the Review Manager 4.27 freeware package (Cochrane Collaboration), SPSS 15.0 statistical package (SPSS Inc), and the R statistical software (version 2.11.0; R Foundation for Statistical Computing). Continuous data were expressed as mean (SD) and categorical data as percentage. The pooled odds ratio for categorical variables was calculated by using the Mantel-Haenszel method, whereas a weighted mean difference was used for continuous variables.23 Data were pooled by fixed-effect method with generic inverse variance weight. The weight of the individual studies was measured as the inverse of the estimated variance of the log hazard ratio (HR) obtained with Cox proportional hazard analysis. Heterogeneity across trials was assessed by the I2 statistic. We additionally performed survival analyses with the use of Cox regression analysis stratified according to trial.5 The proportionality hazards assumption in Cox regression models was tested by using the Score test and Schoenfeld residuals. In case the proportionality assumption was not met, we used a Cox model with time-varying regression coefficients (piecewise time-constant coefficients).24 This means that the entire study period was split in a certain number of time intervals, and the effect of DES (HR) estimated within each of these intervals. The choice of the time intervals was based on estimates of fully time-dependent regression. Kaplan-Meier survival curves are presented with event rates reported as estimated probabilities. Results were considered statistically significant at P < .05 (2-sided), and Bonferroni correction was used to adjust for multiple testing. The study was performed in compliance with the Quality of Reporting of Meta-analyses (QUOROM) guidelines.25

ELIGIBLE STUDIES AND BASELINE CHARACTERISTICS

A total of 16 randomized trials6,2640 were initially identified. Two trials were excluded because of inclusion of both STEMI and non-STEMI patients.29,31 Three other trials were excluded because of small sample size28 or investigator unwillingness to provide individual patient data34,40 (Figure 1). Therefore 11 trials were finally included in the meta-analysis, in which 6298 patients were randomized, including 3980 patients (63.2%) assigned to the DES group and 2318 patients (36.8%) assigned to the BMS group. Characteristics of the included trials are given in Table 1. The length of clinical follow-up varied between 3 and 6 years.

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Figure 1. Drug-eluting stent (DES) and mortality at long-term follow-up. A, Absolute numbers of death and hazard ratios for this end point with DES vs bare-metal stent (BMS) for individual trials and the pooled population. Hazard ratios are shown on a logarithmic scale. The size of the square is proportional to the weight of the individual studies, measured as the inverse of the estimated variance of the log hazard ratio. B, Kaplan-Meier curves of probability of death in each of the stent groups for the pooled population. Trial name acronyms are spelled out in Table 1 footnote.

Table Graphic Jump LocationTable 1. Characteristics of the Randomized Trials Included in the Meta-analysis

In the Paclitaxel or Sirolimus-Eluting Stent vs Bare Metal Stent in Primary Angioplasty (PASEO)33 and Basel Stent Kosten-Effektivitäts in Acute Myocardial Infarction (BASKET-AMI)27 trials, patients were randomized at a ratio of 1:1:1 to BMS, SES, or PES. Routine angiographic follow-up was performed in the randomized study of Sirolimus-Eluting Stent vs Conventional Stent in Acute Myocardial Infarction (SESAMI),35 the prospective randomized controlled trial to evaluate the efficacy of drug-eluting stents vs bare-metal stents for the treatment of acute myocardial infarction (MISSION! Intervention Study),37 and the Drug Elution and Distal Protection in ST-Elevation Myocardial Infarction (DEDICATION) study,36 as well as in a subgroup of patients in the Trial to Assess the Use of Cypher Stent in Acute Myocardial Infarction Treated With Balloon Angioplasty (TYPHOON).39 In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial,6 patients underwent both a pharmacology randomization (bivalirudin or unfractionated heparin plus a glycoprotein IIb-IIIa inhibitor, with a 1:1 randomization ratio) and a stent randomization (Taxus vs Express [Boston Scientific Corporation], with a 3:1 randomization ratio). Baseline characteristics are reported in Table 2; there were no significant differences observed between the 2 groups.

The DES used were SES in 26.7%, PES in 72.3%, and zotarolimus-eluting stents (Endeavor; Medtronic) in 1.0% of patients. No significant differences in baseline characteristics were observed between the 2 groups (Table 2). However, a significantly higher percentage of patients in the DES group were receiving dual antiplatelet therapy (aspirin and clopidogrel) during 3-year follow-up compared with the BMS group (Table 3).

Table Graphic Jump LocationTable 3. Percentage of Patients Receiving Dual Antiplatelet Therapy at Follow-up

At long-term follow-up (mean [SD], 1201 [440] days), a total of 432 patients had died. No significant difference in mortality was observed with DES compared with BMS implantation (8.5% vs 10.2%, respectively; HR, 0.85 [95% CI, 0.70-1.04]; P = .11, P value for heterogeneity, .28) (Figure 1). Similar results were observed with Cox regression analysis stratified according to trial, where the proportionality of hazards was met (P = .46). There were no differences in cardiac mortality between DES and BMS implantation (data available from 9 trials including 5846 patients) (5.7% vs 6.8%, respectively; HR, 0.84 [95% CI, 0.65-1.09]; P = .19, P value for heterogeneity, .20).

Reinfarction was observed in a total of 350 patients. As shown in Figure 2, no significant difference in reinfarction was observed between DES and BMS implantation (9.4% vs 5.9%, respectively; HR, 1.12 [95% CI, 0.88-1.41]; P = .36, P value for heterogeneity, .37). However, the assumption of proportionality of hazards was not met (P = .01), and therefore we additionally used a Cox model with time-varying regression coefficients (piecewise time-constant coefficients). In fact, as given in Table 4, the HR changed across time, suggesting that at long-term follow-up (after 2 years from the beginning of the study) the reinfarction rate increased significantly for the DES group compared with the BMS group (HR, 2.06 [95% CI, 1.22-3.49]; P = .03).

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Figure 2. Drug-eluting stent (DES) and reinfarction at long-term follow-up. A, Absolute numbers of reinfarction and hazard ratios for this end point with DES vs bare-metal stent (BMS) for individual trials and the pooled population (fixed-effect model). Hazard ratios are shown on a logarithmic scale. The size of the square is proportional to the weight of the individual studies, measured as the inverse of the estimated variance of the log hazard ratio. B, Kaplan-Meier curves of probability of reinfarction in each of the stent groups for the pooled population. Trial name acronyms are spelled out in Table 1 footnote.

Table Graphic Jump LocationTable 4. Results of Cox Models With Piecewise Time-Constant Regression Coefficients

Stent thrombosis, according to the ARC definition, was observed in a total of 267 patients (219 definite and 48 probable). As shown in Figure 3, the long-term rate of ST was not significantly different between DES and BMS implantation (5.8% vs 4.3% respectively; HR, 1.13 [95% CI, 0.86-1.47]; P = .38, P value for heterogeneity, .94). However, the assumption of proportionality of hazards was not met (P = .04), and therefore we additionally used a Cox model with time-varying regression coefficients (piecewise time-constant coefficients). In fact, as given in Table 4, the HR changed across time, suggesting that at long-term follow-up (after 2 years from the beginning of the study), the rate of ST increased significantly for the DES group compared with the BMS group (HR, 2.81 [95% CI, 1.28-6.19]; P = .04).

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Figure 3. Drug-eluting stent (DES) and stent thrombosis (definite and probable according to the Academic Research Consortium definitions) at long-term follow-up. A, Absolute numbers of stent thrombosis and hazard ratios for this end point with DES vs bare-metal stent (BMS) for individual trials and the pooled population (fixed-effect model). Hazard ratios are shown on a logarithmic scale. The size of the square is proportional to the weight of the individual studies, measured as the inverse of the estimated variance of the log hazard ratio. B, Kaplan-Meier curves of probability of in-stent thrombosis in each of the stent groups for the pooled population. Trial name acronyms are spelled out in Table 1 footnote.

TARGET-VESSEL REVASCULARIZATION

A total of 837 patients underwent a repeated intervention of the target vessel. As shown in Figure 4, DES use significantly reduced the occurrence of TVR compared with BMS use (12.7% vs 20.1%, respectively; HR, 0.57 [95% CI, 0.50-0.66]; P < .001, P value for heterogeneity, .20) (number needed to treat = 12.2 [95% CI, 10.3-15.4]. Similar results were observed with Cox regression analysis stratified according to trial, where the proportionality of hazards was met (P = .07). Similar findings were observed in terms of target lesion revascularization (data available in 5072 patients from 7 trials) (10.1% [DES] vs 17.9% [BMS]; HR, 0.54 [95% CI, 0.45-0.64]; P < .001, P value for heterogeneity, .10) (number needed to treat, 11.7 [95% CI, 10.1-15.2]).

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Figure 4. Drug-eluting stent (DES) and target-vessel revascularization at long-term follow-up. A, Absolute numbers of target-vessel revascularization and hazard ratios for this end point with DES vs bare-metal stent (BMS) for individual trials and the pooled population (fixed-effect model). Hazard ratios are shown on a logarithmic scale. The size of the square is proportional to the weight of the individual studies, measured as the inverse of the estimated variance of the log hazard ratio. B, Kaplan-Meier curves of probability of target-vessel revascularization in each of the stent groups for the pooled population. Trial name acronyms are spelled out in Table 1 footnote.

The present study represents, to our knowledge, the first meta-analysis reporting on long-term clinical outcome (mean [SD], 3.3 [1.2] years) of DES in the setting of primary PCI for STEMI based on individual patient-level data. The principal finding from our study is that among patients with STEMI undergoing primary PCI, compared with BMS, SES and PES are associated with significant and sustained reductions in TVR, without significant differences in ST, reinfarction, or death. Reductions in TVR were noted with DES in both the early and very late periods. However, we observed a significantly higher occurrence of very late reinfarction and ST with these DES compared with BMS.

Early after its introduction, stenting had been avoided in the setting of STEMI because of concerns that implantation of a metallic device within a thrombotic environment such as that of a plaque disruption resulting in myocardial infarction might predispose to ST with resultant vessel occlusion. Vigorous anticoagulation—necessary to avoid ST—exposed the patient to the risks of bleeding and vascular complications.41 However, following improvements in stent deployment techniques and advances in antiplatelet therapy,46,42,43 numerous studies and randomized trials demonstrated the safety and efficacy of BMS in the setting of STEMI.79,4446 Previous meta-analyses in patients undergoing primary PCI have shown the benefits of stenting compared with balloon angioplasty alone in terms of reducing TVR, though no definite impact on death or reinfarction was present.9 However, restenosis rates after BMS implantation, in patients with STEMI are still high, especially in unselected patients with complex lesion morphology.47 Several initial randomized trials have shown that, among patients without acute coronary syndromes, DES implantation is associated with a significant reduction in restenosis and TVR.1014 However, concerns emerged regarding an increased risk of very late ST associated with DES implantation.1822 As most episodes of ST result in myocardial infarction, the increased rate of very late ST with DES implantation may have an impact on mortality, particularly after primary PCI in STEMI, since reinfarction is a major determinant of mortality.47,48

In a recent prospective multicenter primary PCI registry (PREMIER [Prospective Registry Evaluating Myocardial Infarction: Events and Recovery]), the use of DES rather than BMS was associated with a high risk of mortality within the first 6 months (presumably due to ST) in cases of early discontinuation of dual antiplatelet therapy.20,21 In this regard it may be difficult to forecast future long-term patient medication compliance at the time of intervention for STEMI.18

Several meta-analyses have been conducted in many settings on long-term follow-up data, showing contrasting results in terms of higher ST with DES,4954 in particular in STEMI. However, in this specific setting, no concern has emerged so far in almost all the randomized trials, potentially because of underpowering.

The results of the present study, based on individual patients' data, provide strong evidence of the beneficial effects of SES and PES during primary PCI in STEMI. With follow-up as late as 6 years, a robust and sustained decrease in TVR was noted with use of these DES. Although the rates of late reinfarction and ST progressively increased, with the difference becoming statistically significant after 2 years in patients receiving SES and PES, the HR for mortality, while not significantly different between DES and BMS, favored DES.

The increase in very late reinfarction and ST in the DES group bears discussion. Similarly to our data, in a large report of patients with stable coronary artery disease undergoing elective stent implantation, PES has been associated with an increased rate of very late myocardial infarction (>1 year) compared with BMS.55 However, both experiences have also found no significant differences in survival between the BMS and DES groups, potentially because of the beneficial effects from preventing restenosis.56 The lower mortality with DES use, despite the higher rates of late reinfarction and ST, may also be explained by the time-related prognostic impact of in-stent thrombosis. In fact, both early and late ST carry a worst prognostic on survival compared with very late in-stent thrombosis.57

Recent studies have shown that newer-generation DES (with thinner, fracture-resistant stent struts, and novel biocompatible polymers) are associated with significantly improved clinical outcomes and reduced ST rates.5860 Future randomized trials are needed to evaluate the safety and efficacy of these DES in the setting of primary PCI in STEMI, especially coupled with the benefits from more potent and/or prolonged dual antiplatelet therapy.61,62

There are some limitations to this study. The patients enrolled in the current randomized trials were highly selected, with few patients having cardiogenic shock. Thus the conclusion of this meta-analysis cannot be extended to all patients undergoing primary PCI for STEMI. We were not able to obtain individual data from 2 randomized trials, including 920 patients.34,40 However, the inclusion of these 2 studies would have certainly not changed our conclusions, especially in terms of mortality. Availability of costs at discharge and at follow-up would have further improved our results. However, these data were not routinely collected in almost all trials. Approximately 5.5% of patients (n = 346) were lost to follow-up within the first 2 years (most of them [61%] from the TYPHOON study). In fact, long-term follow-up was not an end point in some of the included studies. However, the results did not change after the exclusion of these patients (data not shown). Even though clinically relevant, exact information on adherence/compliance to the prescription of dual antiplatelet therapy was not routinely collected.

Our study was certainly underpowered to show a statistically significant difference in mortality between the groups. In fact, based on the 3-year results (0.8% absolute mortality reduction), with a significance level (α) of .05 and a statistical power of 0.8, we would have needed a population of 30 130 (19 084 with DES and 11 226 with BMS) to reach this end point.

Finally, the results of the current analysis apply only to Cypher (SES) and Taxus (PES), as substantial randomized studies in STEMI have not yet been performed with newer DES. However, the huge number of patients treated worldwide with first-generation DES in the setting of STEMI in the last few years certainly support the high clinical relevance of our findings at long-term follow-up, especially concerning the potential prolongation of dual antiplatelet therapy.

In conclusion, the present meta-analysis, based on pooled patient-level data from 11 trials with 6270 randomized patients, shows that among selected patients with STEMI undergoing primary PCI, compared with BMS, SES and PES, are associated with a significant reduction in TVR and target-lesion revascularization at long-term follow-up. Despite a slightly higher rate of very late reinfarction and ST with SES and PES compared with BMS, there were no significant differences in overall or very late mortality, with the point estimate favoring DES in all periods.

Correspondence: Giuseppe De Luca, MD, PhD, Division of Cardiology, Ospedale “Maggiore della Carità,” Eastern Piedmont University, C.so Mazzini 18, 24100 Novara, Italy (giuseppe.deluca@maggioreosp.novara.it).

Accepted for Publication: February 13, 2012.

Author Contributions: Dr De Luca had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: De Luca, Kelbæk, Pasceri, and Stone. Acquisition of data: De Luca, Dirksen, Spaulding, Kelbæk, Schalij, Thuesen, van der Hoeven, Vink, Kaiser, Kaiser, Musto, Chechi, Spaziani, Díaz de la Llera, Pasceri, Di Lorenzo, and Violini. Analysis and interpretation of data: De Luca, Dirksen, Spaulding, Kelbæk, van der Hoeven, Vink, Díaz de la Llera, Cortese, Suryapranata, and Stone. Drafting of the manuscript: De Luca. Critical revision of the manuscript for important intellectual content: Dirksen, Spaulding, Kelbæk, Schalij, Thuesen, van der Hoeven, Vink, Kaiser, Kaiser, Musto, Chechi, Spaziani, Díaz de la Llera, Pasceri, Di Lorenzo, Violini, Cortese, Suryapranata, and Stone. Statistical analysis: De Luca, Spaulding, and Cortese. Obtained funding: Spaulding and Thuesen. Administrative, technical, and material support: Dirksen, Spaulding, Kelbæk, Schalij, Thuesen, van der Hoeven, Vink, and Pasceri. Study supervision: Dirksen, Spaulding, Musto, Chechi, Spaziani, Díaz de la Llera, Pasceri, Di Lorenzo, Violini, Suryapranata, and Stone.

Financial Disclosure: The Department of Cardiology, Leiden University Medical Center (Dr Schalij), receives research grants from Boston Scientific, Medtronic, and Biotronik. Dr Kaiser is on the advisory board at Ely Lilly and received research/travel support from Abbott Vascular. Dr Stone is a consultant to Abbott Vascular, Boston Scientific, Medtronic.

Zijlstra F, Hoorntje JC, de Boer MJ,  et al.  Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction.  N Engl J Med. 1999;341(19):1413-1419
PubMed   |  Link to Article
Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials.  Lancet. 2003;361(9351):13-20
PubMed   |  Link to Article
Bhatt DL, Bertrand ME, Berger PB,  et al.  Meta-analysis of randomized and registry comparisons of ticlopidine with clopidogrel after stenting.  J Am Coll Cardiol. 2002;39(1):9-14
PubMed   |  Link to Article
De Luca G, Suryapranata H, Stone GW,  et al.  Abciximab as adjunctive therapy to reperfusion in acute ST-segment elevation myocardial infarction: a meta-analysis of randomized trials.  JAMA. 2005;293(14):1759-1765
PubMed   |  Link to Article
De Luca G, Gibson CM, Bellandi F,  et al.  Early glycoprotein IIb-IIIa inhibitors in primary angioplasty (EGYPT) cooperation: an individual patient data meta-analysis.  Heart. 2008;94(12):1548-1558
PubMed   |  Link to Article
Stone GW, Witzenbichler B, Guagliumi G,  et al;  HORIZONS-AMI Trial Investigators.  Heparin plus a glycoprotein IIb/IIIa inhibitor versus bivalirudin monotherapy and paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction (HORIZONS-AMI): final 3-year results from a multicentre, randomised controlled trial.  Lancet. 2011;377(9784):2193-2204
PubMed   |  Link to Article
Stone GW, Grines CL, Cox DA,  et al; Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Investigators.  Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction.  N Engl J Med. 2002;346(13):957-966
PubMed   |  Link to Article
Suryapranata H, De Luca G, van 't Hof AW,  et al.  Is routine stenting for acute myocardial infarction superior to balloon angioplasty? a randomised comparison in a large cohort of unselected patients.  Heart. 2005;91(5):641-645
PubMed   |  Link to Article
De Luca G, Suryapranata H, Stone GW,  et al.  Coronary stenting versus balloon angioplasty for acute myocardial infarction: a meta-regression analysis of randomized trials.  Int J Cardiol. 2008;126(1):37-44
PubMed   |  Link to Article
Moses JW, Leon MB, Popma JJ,  et al; SIRIUS Investigators.  Sirolimus-eluting stents versus standard stents in patients with stenosis in a nativecoronary artery.  N Engl J Med. 2003;349(14):1315-1323
PubMed   |  Link to Article
Stone GW, Ellis SG, Cox DA,  et al; TAXUS-IV Investigators.  A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease.  N Engl J Med. 2004;350(3):221-231
PubMed   |  Link to Article
Ardissino D, Cavallini C, Bramucci E,  et al; SES-SMART Investigators.  Sirolimus-eluting vs uncoated stents for prevention of restenosis in small coronary arteries: a randomized trial.  JAMA. 2004;292(22):2727-2734
PubMed   |  Link to Article
Colombo A, Moses JW, Morice MC,  et al.  Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions.  Circulation. 2004;109(10):1244-1249
PubMed   |  Link to Article
Roiron C, Sanchez P, Bouzamondo A, Lechat P, Montalescot G. Drug eluting stents: an updated meta-analysis of randomised controlled trials.  Heart. 2006;92(5):641-649
PubMed   |  Link to Article
De Luca G, Stone GW, Suryapranata H,  et al.  Efficacy and safety of drug-eluting stents in ST-segment elevation myocardial infarction: a meta-analysis of randomized trials.  Int J Cardiol. 2009;133(2):213-222
PubMed   |  Link to Article
De Luca G, Valgimigli M, Spaulding C,  et al.  Short and long-term benefits of sirolimus-eluting stent in ST-segment elevation myocardial infarction: a meta-analysis of randomized trials.  J Thromb Thrombolysis. 2009;28(2):200-210
PubMed   |  Link to Article
Dibra A, Tiroch K, Schulz S,  et al.  Drug-eluting stents in acute myocardial infarction: updated meta-analysis of randomized trials.  Clin Res Cardiol. 2010;99(6):345-357
PubMed   |  Link to Article
McFadden EP, Stabile E, Regar E,  et al.  Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy.  Lancet. 2004;364(9444):1519-1521
PubMed   |  Link to Article
Iakovou I, Schmidt T, Bonizzoni E,  et al.  Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents.  JAMA. 2005;293(17):2126-2130
PubMed   |  Link to Article
Spertus JA, Kettelkamp R, Vance C,  et al.  Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry.  Circulation. 2006;113(24):2803-2809
PubMed   |  Link to Article
Kernis SJ, Cohen D, Rein K. Clinical outcome associated with use of drug-eluting stents compared with bare metal stent for primary percutaneous intervention [abstract].  Am J Cardiol. 2005;96:(suppl 7A)  47H
Daemen J, Tanimoto S, García-García HM,  et al.  Comparison of three-year clinical outcome of sirolimus- and paclitaxel-eluting stents versus bare metal stents in patients with ST-segment elevation myocardial infarction (from the RESEARCH and T-SEARCH Registries).  Am J Cardiol. 2007;99(8):1027-1032
PubMed   |  Link to Article
Egger M, Smith GD. Bias in location and selection of studies.  BMJ. 1998;316(7124):61-66
PubMed   |  Link to Article
Cortese G, Scheike TH, Martinussen T. Flexible survival regression modelling.  Stat Methods Med Res. 2010;19(1):5-28
PubMed   |  Link to Article
Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement: quality of reporting of meta-analyses.  Lancet. 1999;354(9193):1896-1900
PubMed   |  Link to Article
Pasceri V, Granatelli A, Pristipino C. A randomized trial of a rapamycin-eluting stent in acute myocardial infarction: preliminary results [abstract].  Am J Cardiol. 2003;92:(suppl 6A)  1L
PubMed
Pittl U, Kaiser C, Brunner-La Rocca HP.BASKET Investigators.  Safety and efficacy of drug eluting stents vs bare metal stents in primary angioplasty of patients with acute ST-elevation myocardial infarction—a prospective randomized study [abstract].  Eur Heart J. 2006;27:(abstract suppl)  650
Sardella G, Paroli M, Mancone M. Impact of paclitaxel-eluting stent implantation in patients with STEMI on anti-inflammatory IL-10-producing T regulatory 1 (Tr1) cells [abstract].  Eur Heart J. 2006;27:(abstract suppl)  831
Tierala I. Helsinki Area Acute Myocardial Infarction Treatment Re-Evaluation—should the patient get a drug-eluting or a normal stent (HAAMU-STENT) study. http://www.tctmd.com/show.aspx?id=398&ref_id=48792. Accessed May 2011
Chechi T, Vittori G, Biondi Zoccai GG,  et al.  Single-center randomized evaluation of paclitaxel-eluting versus conventional stent in acute myocardial infarction (SELECTION).  J Interv Cardiol. 2007;20(4):282-291
PubMed   |  Link to Article
Karjalainen P. TITAX AMI Trial. http://www.slideshare.net/benklinger/titax-tct-2007. Accessed May 2011
Díaz de la Llera LS, Ballesteros S, Nevado J,  et al.  Sirolimus-eluting stents compared with standard stents in the treatment of patients with primary angioplasty.  Am Heart J. 2007;154(1):164.e1-164.e6
PubMed   |  Link to Article
Di Lorenzo E, Sauro R, Varricchio A,  et al.  Benefits of drug-eluting stents as compared to bare metal stent in ST-segment elevation myocardial infarction: four year results of the PaclitAxel or Sirolimus-Eluting stent vs bare metal stent in primary angiOplasty (PASEO) randomized trial.  Am Heart J. 2009;158(4):e43-e50
PubMed   |  Link to Article
Tebaldi M, Arcozzi C, Campo G, Percoco G, Ferrari R, Valgimigli M.STRATEGY Investigators.  The 5-year clinical outcomes after a randomized comparison of sirolimus-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction.  J Am Coll Cardiol. 2009;54(20):1900-1901
PubMed   |  Link to Article
Violini R, Musto C, De Felice F,  et al.  Maintenance of long-term clinical benefit with sirolimus-eluting stents in patients with ST-segment elevation myocardial infarction 3-year results of the SESAMI (sirolimus-eluting stent versus bare-metal stent in acute myocardial infarction) trial.  J Am Coll Cardiol. 2010;55(8):810-814
PubMed   |  Link to Article
Kaltoft A, Kelbaek H, Thuesen L,  et al.  Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: 3-year follow-up of the randomized DEDICATION (Drug Elution and Distal Protection in Acute Myocardial Infarction) Trial.  J Am Coll Cardiol. 2010;56(8):641-645
PubMed   |  Link to Article
Atary JZ, van der Hoeven BL, Liem SS,  et al.  Three-year outcome of sirolimus-eluting versus bare-metal stents for the treatment of ST-segment elevation myocardial infarction (from the MISSION! Intervention Study).  Am J Cardiol. 2010;106(1):4-12
PubMed   |  Link to Article
Vink MA, Dirksen MT, Suttorp MJ,  et al.  5-year follow-up after primary percutaneous coronary intervention with a paclitaxel-eluting stent versus a bare-metal stent in acute ST-segment elevation myocardial infarction: a follow-up study of the PASSION (Paclitaxel-Eluting Versus Conventional Stent in Myocardial Infarction with ST-Segment Elevation) trial.  JACC Cardiovasc Interv. 2011;4(1):24-29
PubMed   |  Link to Article
Spaulding C, Teiger E, Commeau P,  et al.  Four-year follow-up of TYPHOON (trial to assess the use of the CYPHer sirolimus-eluting coronary stent in acute myocardial infarction treated with BallOON angioplasty).  JACC Cardiovasc Interv. 2011;4(1):14-23
PubMed   |  Link to Article
Valgimigli M, Campo G, Gambetti S,  et al;  MULTIcentre evaluation of Single high-dose bolus TiRofiban vs Abciximab with sirolimus eluting sTEnt or Bare Metal Stent in Acute Myocardial Infarction studY (MULTISTRATEGY) investigators.  Three-year follow-up of the MULTIcentre evaluation of Single high-dose Bolus TiRofiban versus Abciximab with Sirolimus-eluting STEnt or Bare-Metal Stent in Acute Myocardial Infarction StudY (MULTISTRATEGY) [published online August 24, 2011].  Int J Cardiol
PubMed  |  Link to Article
George BS, Voorhees WD III, Roubin GS,  et al.  Multicenter investigation of coronary stenting to treat acute or threatened closure after percutaneous transluminal coronary angioplasty: clinical and angiographic outcomes.  J Am Coll Cardiol. 1993;22(1):135-143
PubMed   |  Link to Article
Schömig A, Neumann FJ, Kastrati A,  et al.  A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents.  N Engl J Med. 1996;334(17):1084-1089
PubMed   |  Link to Article
EPISTENT Investigators.  Randomised placebo-controlled and balloon-angioplasty-controlled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb/IIIa blockade.  Lancet. 1998;352(9122):87-92
PubMed   |  Link to Article
Suryapranata H, van 't Hof AW, Hoorntje JC, de Boer MJ, Zijlstra F. Randomized comparison of coronary stenting with balloon angioplasty in selected patients with acute myocardial infarction.  Circulation. 1998;97(25):2502-2505
PubMed
Antoniucci D, Santoro GM, Bolognese L, Valenti R, Trapani M, Fazzini PF. A clinical trial comparing primary stenting of the infarct-related artery with optimal primary angioplasty for acute myocardial infarction: results from the Florence Randomized Elective Stenting in Acute Coronary Occlusions (FRESCO) trial.  J Am Coll Cardiol. 1998;31(6):1234-1239
PubMed   |  Link to Article
Grines CL, Cox DA, Stone GW,  et al; Stent Primary Angioplasty in Myocardial Infarction Study Group.  Coronary angioplasty with or without stent implantation for acute myocardial infarction.  N Engl J Med. 1999;341(26):1949-1956
PubMed   |  Link to Article
Gibson CM, Karha J, Murphy SA,  et al; TIMI Study Group.  Early and long-term clinical outcomes associated with reinfarction following fibrinolytic administration in the Thrombolysis in Myocardial Infarction trials.  J Am Coll Cardiol. 2003;42(1):7-16
PubMed   |  Link to Article
De Luca G, Ernst N, van 't Hof AW,  et al.  Predictors and clinical implications of early reinfarction after primary angioplasty for ST-segment elevation myocardial infarction.  Am Heart J. 2006;151(6):1256-1259
PubMed   |  Link to Article
Stettler C, Wandel S, Allemann S,  et al.  Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis.  Lancet. 2007;370(9591):937-948
PubMed   |  Link to Article
Hakeem A, Helmy T, Munsif S,  et al.  Safety and efficacy of drug eluting stents compared with bare metal stents for saphenous vein graft interventions: a comprehensive meta-analysis of randomized trials and observational studies comprising 7,994 patients.  Catheter Cardiovasc Interv. 2011;77(3):343-355
PubMed   |  Link to Article
Cortese B, Bertoletti A, De Matteis S, Danzi GB, Kastrati A. Drug-eluting stents perform better than bare metal stents in small coronary vessels: a meta-analysis of randomised and observational clinical studies with mid-term follow up [published online May 13, 2011].  Int J CardiolLink to Article
PubMed
Ma J, Yang W, Singh M, Peng T, Fang N, Wei M. Meta-analysis of long-term outcomes of drug-eluting stent implantations for chronic total coronary occlusions.  Heart Lung. 2011;40(3):e32-e40
PubMed   |  Link to Article
Piccolo R, Cassese S, Galasso G, De Rosa R, D’Anna C, Piscione F. Long-term safety and efficacy of drug-eluting stents in patients with acute myocardial infarction: a meta-analysis of randomized trials.  Atherosclerosis. 2011;217(1):149-157
PubMed   |  Link to Article
Wallace EL, Abdel-Latif A, Charnigo R, Moliterno DJ, Brodie B, Matnani R, Ziada KM. Meta-analysis of long-term outcomes for drug-eluting stents versus bare-metal stents in primary percutaneous coronary interventions for ST-segment elevation myocardial infarction [published online January 3, 2012].  Am J Cardiol
PubMed  |  Link to Article
Stone GW, Ellis SG, Colombo A,  et al.  Long-term safety and efficacy of paclitaxel-eluting stents final 5-year analysis from the TAXUS Clinical Trial Program.  JACC Cardiovasc Interv. 2011;4(5):530-542
PubMed   |  Link to Article
Stone GW, Ellis SG, Colombo A,  et al.  Offsetting impact of thrombosis and restenosis on the occurrence of death and myocardial infarction after paclitaxel-eluting and bare metal stent implantation.  Circulation. 2007;115(22):2842-2847
PubMed   |  Link to Article
Kereiakes DJ, Smits PC, Kedhi E,  et al.  Predictors of death or myocardial infarction, ischaemic-driven revascularisation, and major adverse cardiovascular events following everolimus-eluting or paclitaxel-eluting stent deployment: pooled analysis from the SPIRIT II, III, IV and COMPARE trials.  EuroIntervention. 2011;7(1):74-83
PubMed   |  Link to Article
Kimura T, Morimoto T, Kozuma K,  et al;  RESTART Investigators.  Comparisons of baseline demographics, clinical presentation, and long-term outcome among patients with early, late, and very late stent thrombosis of sirolimus-eluting stents: observations from the Registry of Stent Thrombosis for Review and Reevaluation (RESTART).  Circulation. 2010;122(1):52-61
PubMed   |  Link to Article
Windecker S, Serruys PW, Wandel S,  et al.  Biolimus-eluting stent with biodegradable polymer versus sirolimus-eluting stent with durable polymer for coronary revascularisation (LEADERS): a randomised non-inferiority trial.  Lancet. 2008;372(9644):1163-1173
PubMed   |  Link to Article
Navarese EP, Kubica J, Castriota F,  et al.  Safety and efficacy of biodegradable vs. durable polymer drug-eluting stents: evidence from a meta-analysis of randomised trials.  EuroIntervention. 2011;7(8):985-994
PubMed   |  Link to Article
Wallentin L, Becker RC, Budaj A,  et al; PLATO Investigators.  Ticagrelor versus clopidogrel in patients with acute coronary syndromes.  N Engl J Med. 2009;361(11):1045-1057
PubMed   |  Link to Article
Wiviott SD, Braunwald E, McCabe CH,  et al;  TRITON-TIMI 38 Investigators.  Prasugrel versus clopidogrel in patients with acute coronary syndromes.  N Engl J Med. 2007;357(20):2001-2015
PubMed   |  Link to Article

Figures

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Graphic Jump Location

Figure 1. Drug-eluting stent (DES) and mortality at long-term follow-up. A, Absolute numbers of death and hazard ratios for this end point with DES vs bare-metal stent (BMS) for individual trials and the pooled population. Hazard ratios are shown on a logarithmic scale. The size of the square is proportional to the weight of the individual studies, measured as the inverse of the estimated variance of the log hazard ratio. B, Kaplan-Meier curves of probability of death in each of the stent groups for the pooled population. Trial name acronyms are spelled out in Table 1 footnote.

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Graphic Jump Location

Figure 2. Drug-eluting stent (DES) and reinfarction at long-term follow-up. A, Absolute numbers of reinfarction and hazard ratios for this end point with DES vs bare-metal stent (BMS) for individual trials and the pooled population (fixed-effect model). Hazard ratios are shown on a logarithmic scale. The size of the square is proportional to the weight of the individual studies, measured as the inverse of the estimated variance of the log hazard ratio. B, Kaplan-Meier curves of probability of reinfarction in each of the stent groups for the pooled population. Trial name acronyms are spelled out in Table 1 footnote.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 3. Drug-eluting stent (DES) and stent thrombosis (definite and probable according to the Academic Research Consortium definitions) at long-term follow-up. A, Absolute numbers of stent thrombosis and hazard ratios for this end point with DES vs bare-metal stent (BMS) for individual trials and the pooled population (fixed-effect model). Hazard ratios are shown on a logarithmic scale. The size of the square is proportional to the weight of the individual studies, measured as the inverse of the estimated variance of the log hazard ratio. B, Kaplan-Meier curves of probability of in-stent thrombosis in each of the stent groups for the pooled population. Trial name acronyms are spelled out in Table 1 footnote.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 4. Drug-eluting stent (DES) and target-vessel revascularization at long-term follow-up. A, Absolute numbers of target-vessel revascularization and hazard ratios for this end point with DES vs bare-metal stent (BMS) for individual trials and the pooled population (fixed-effect model). Hazard ratios are shown on a logarithmic scale. The size of the square is proportional to the weight of the individual studies, measured as the inverse of the estimated variance of the log hazard ratio. B, Kaplan-Meier curves of probability of target-vessel revascularization in each of the stent groups for the pooled population. Trial name acronyms are spelled out in Table 1 footnote.

Tables

Table Graphic Jump LocationTable 1. Characteristics of the Randomized Trials Included in the Meta-analysis
Table Graphic Jump LocationTable 3. Percentage of Patients Receiving Dual Antiplatelet Therapy at Follow-up
Table Graphic Jump LocationTable 4. Results of Cox Models With Piecewise Time-Constant Regression Coefficients

References

Zijlstra F, Hoorntje JC, de Boer MJ,  et al.  Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction.  N Engl J Med. 1999;341(19):1413-1419
PubMed   |  Link to Article
Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials.  Lancet. 2003;361(9351):13-20
PubMed   |  Link to Article
Bhatt DL, Bertrand ME, Berger PB,  et al.  Meta-analysis of randomized and registry comparisons of ticlopidine with clopidogrel after stenting.  J Am Coll Cardiol. 2002;39(1):9-14
PubMed   |  Link to Article
De Luca G, Suryapranata H, Stone GW,  et al.  Abciximab as adjunctive therapy to reperfusion in acute ST-segment elevation myocardial infarction: a meta-analysis of randomized trials.  JAMA. 2005;293(14):1759-1765
PubMed   |  Link to Article
De Luca G, Gibson CM, Bellandi F,  et al.  Early glycoprotein IIb-IIIa inhibitors in primary angioplasty (EGYPT) cooperation: an individual patient data meta-analysis.  Heart. 2008;94(12):1548-1558
PubMed   |  Link to Article
Stone GW, Witzenbichler B, Guagliumi G,  et al;  HORIZONS-AMI Trial Investigators.  Heparin plus a glycoprotein IIb/IIIa inhibitor versus bivalirudin monotherapy and paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction (HORIZONS-AMI): final 3-year results from a multicentre, randomised controlled trial.  Lancet. 2011;377(9784):2193-2204
PubMed   |  Link to Article
Stone GW, Grines CL, Cox DA,  et al; Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Investigators.  Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction.  N Engl J Med. 2002;346(13):957-966
PubMed   |  Link to Article
Suryapranata H, De Luca G, van 't Hof AW,  et al.  Is routine stenting for acute myocardial infarction superior to balloon angioplasty? a randomised comparison in a large cohort of unselected patients.  Heart. 2005;91(5):641-645
PubMed   |  Link to Article
De Luca G, Suryapranata H, Stone GW,  et al.  Coronary stenting versus balloon angioplasty for acute myocardial infarction: a meta-regression analysis of randomized trials.  Int J Cardiol. 2008;126(1):37-44
PubMed   |  Link to Article
Moses JW, Leon MB, Popma JJ,  et al; SIRIUS Investigators.  Sirolimus-eluting stents versus standard stents in patients with stenosis in a nativecoronary artery.  N Engl J Med. 2003;349(14):1315-1323
PubMed   |  Link to Article
Stone GW, Ellis SG, Cox DA,  et al; TAXUS-IV Investigators.  A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease.  N Engl J Med. 2004;350(3):221-231
PubMed   |  Link to Article
Ardissino D, Cavallini C, Bramucci E,  et al; SES-SMART Investigators.  Sirolimus-eluting vs uncoated stents for prevention of restenosis in small coronary arteries: a randomized trial.  JAMA. 2004;292(22):2727-2734
PubMed   |  Link to Article
Colombo A, Moses JW, Morice MC,  et al.  Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions.  Circulation. 2004;109(10):1244-1249
PubMed   |  Link to Article
Roiron C, Sanchez P, Bouzamondo A, Lechat P, Montalescot G. Drug eluting stents: an updated meta-analysis of randomised controlled trials.  Heart. 2006;92(5):641-649
PubMed   |  Link to Article
De Luca G, Stone GW, Suryapranata H,  et al.  Efficacy and safety of drug-eluting stents in ST-segment elevation myocardial infarction: a meta-analysis of randomized trials.  Int J Cardiol. 2009;133(2):213-222
PubMed   |  Link to Article
De Luca G, Valgimigli M, Spaulding C,  et al.  Short and long-term benefits of sirolimus-eluting stent in ST-segment elevation myocardial infarction: a meta-analysis of randomized trials.  J Thromb Thrombolysis. 2009;28(2):200-210
PubMed   |  Link to Article
Dibra A, Tiroch K, Schulz S,  et al.  Drug-eluting stents in acute myocardial infarction: updated meta-analysis of randomized trials.  Clin Res Cardiol. 2010;99(6):345-357
PubMed   |  Link to Article
McFadden EP, Stabile E, Regar E,  et al.  Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy.  Lancet. 2004;364(9444):1519-1521
PubMed   |  Link to Article
Iakovou I, Schmidt T, Bonizzoni E,  et al.  Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents.  JAMA. 2005;293(17):2126-2130
PubMed   |  Link to Article
Spertus JA, Kettelkamp R, Vance C,  et al.  Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry.  Circulation. 2006;113(24):2803-2809
PubMed   |  Link to Article
Kernis SJ, Cohen D, Rein K. Clinical outcome associated with use of drug-eluting stents compared with bare metal stent for primary percutaneous intervention [abstract].  Am J Cardiol. 2005;96:(suppl 7A)  47H
Daemen J, Tanimoto S, García-García HM,  et al.  Comparison of three-year clinical outcome of sirolimus- and paclitaxel-eluting stents versus bare metal stents in patients with ST-segment elevation myocardial infarction (from the RESEARCH and T-SEARCH Registries).  Am J Cardiol. 2007;99(8):1027-1032
PubMed   |  Link to Article
Egger M, Smith GD. Bias in location and selection of studies.  BMJ. 1998;316(7124):61-66
PubMed   |  Link to Article
Cortese G, Scheike TH, Martinussen T. Flexible survival regression modelling.  Stat Methods Med Res. 2010;19(1):5-28
PubMed   |  Link to Article
Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement: quality of reporting of meta-analyses.  Lancet. 1999;354(9193):1896-1900
PubMed   |  Link to Article
Pasceri V, Granatelli A, Pristipino C. A randomized trial of a rapamycin-eluting stent in acute myocardial infarction: preliminary results [abstract].  Am J Cardiol. 2003;92:(suppl 6A)  1L
PubMed
Pittl U, Kaiser C, Brunner-La Rocca HP.BASKET Investigators.  Safety and efficacy of drug eluting stents vs bare metal stents in primary angioplasty of patients with acute ST-elevation myocardial infarction—a prospective randomized study [abstract].  Eur Heart J. 2006;27:(abstract suppl)  650
Sardella G, Paroli M, Mancone M. Impact of paclitaxel-eluting stent implantation in patients with STEMI on anti-inflammatory IL-10-producing T regulatory 1 (Tr1) cells [abstract].  Eur Heart J. 2006;27:(abstract suppl)  831
Tierala I. Helsinki Area Acute Myocardial Infarction Treatment Re-Evaluation—should the patient get a drug-eluting or a normal stent (HAAMU-STENT) study. http://www.tctmd.com/show.aspx?id=398&ref_id=48792. Accessed May 2011
Chechi T, Vittori G, Biondi Zoccai GG,  et al.  Single-center randomized evaluation of paclitaxel-eluting versus conventional stent in acute myocardial infarction (SELECTION).  J Interv Cardiol. 2007;20(4):282-291
PubMed   |  Link to Article
Karjalainen P. TITAX AMI Trial. http://www.slideshare.net/benklinger/titax-tct-2007. Accessed May 2011
Díaz de la Llera LS, Ballesteros S, Nevado J,  et al.  Sirolimus-eluting stents compared with standard stents in the treatment of patients with primary angioplasty.  Am Heart J. 2007;154(1):164.e1-164.e6
PubMed   |  Link to Article
Di Lorenzo E, Sauro R, Varricchio A,  et al.  Benefits of drug-eluting stents as compared to bare metal stent in ST-segment elevation myocardial infarction: four year results of the PaclitAxel or Sirolimus-Eluting stent vs bare metal stent in primary angiOplasty (PASEO) randomized trial.  Am Heart J. 2009;158(4):e43-e50
PubMed   |  Link to Article
Tebaldi M, Arcozzi C, Campo G, Percoco G, Ferrari R, Valgimigli M.STRATEGY Investigators.  The 5-year clinical outcomes after a randomized comparison of sirolimus-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction.  J Am Coll Cardiol. 2009;54(20):1900-1901
PubMed   |  Link to Article
Violini R, Musto C, De Felice F,  et al.  Maintenance of long-term clinical benefit with sirolimus-eluting stents in patients with ST-segment elevation myocardial infarction 3-year results of the SESAMI (sirolimus-eluting stent versus bare-metal stent in acute myocardial infarction) trial.  J Am Coll Cardiol. 2010;55(8):810-814
PubMed   |  Link to Article
Kaltoft A, Kelbaek H, Thuesen L,  et al.  Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: 3-year follow-up of the randomized DEDICATION (Drug Elution and Distal Protection in Acute Myocardial Infarction) Trial.  J Am Coll Cardiol. 2010;56(8):641-645
PubMed   |  Link to Article
Atary JZ, van der Hoeven BL, Liem SS,  et al.  Three-year outcome of sirolimus-eluting versus bare-metal stents for the treatment of ST-segment elevation myocardial infarction (from the MISSION! Intervention Study).  Am J Cardiol. 2010;106(1):4-12
PubMed   |  Link to Article
Vink MA, Dirksen MT, Suttorp MJ,  et al.  5-year follow-up after primary percutaneous coronary intervention with a paclitaxel-eluting stent versus a bare-metal stent in acute ST-segment elevation myocardial infarction: a follow-up study of the PASSION (Paclitaxel-Eluting Versus Conventional Stent in Myocardial Infarction with ST-Segment Elevation) trial.  JACC Cardiovasc Interv. 2011;4(1):24-29
PubMed   |  Link to Article
Spaulding C, Teiger E, Commeau P,  et al.  Four-year follow-up of TYPHOON (trial to assess the use of the CYPHer sirolimus-eluting coronary stent in acute myocardial infarction treated with BallOON angioplasty).  JACC Cardiovasc Interv. 2011;4(1):14-23
PubMed   |  Link to Article
Valgimigli M, Campo G, Gambetti S,  et al;  MULTIcentre evaluation of Single high-dose bolus TiRofiban vs Abciximab with sirolimus eluting sTEnt or Bare Metal Stent in Acute Myocardial Infarction studY (MULTISTRATEGY) investigators.  Three-year follow-up of the MULTIcentre evaluation of Single high-dose Bolus TiRofiban versus Abciximab with Sirolimus-eluting STEnt or Bare-Metal Stent in Acute Myocardial Infarction StudY (MULTISTRATEGY) [published online August 24, 2011].  Int J Cardiol
PubMed  |  Link to Article
George BS, Voorhees WD III, Roubin GS,  et al.  Multicenter investigation of coronary stenting to treat acute or threatened closure after percutaneous transluminal coronary angioplasty: clinical and angiographic outcomes.  J Am Coll Cardiol. 1993;22(1):135-143
PubMed   |  Link to Article
Schömig A, Neumann FJ, Kastrati A,  et al.  A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents.  N Engl J Med. 1996;334(17):1084-1089
PubMed   |  Link to Article
EPISTENT Investigators.  Randomised placebo-controlled and balloon-angioplasty-controlled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb/IIIa blockade.  Lancet. 1998;352(9122):87-92
PubMed   |  Link to Article
Suryapranata H, van 't Hof AW, Hoorntje JC, de Boer MJ, Zijlstra F. Randomized comparison of coronary stenting with balloon angioplasty in selected patients with acute myocardial infarction.  Circulation. 1998;97(25):2502-2505
PubMed
Antoniucci D, Santoro GM, Bolognese L, Valenti R, Trapani M, Fazzini PF. A clinical trial comparing primary stenting of the infarct-related artery with optimal primary angioplasty for acute myocardial infarction: results from the Florence Randomized Elective Stenting in Acute Coronary Occlusions (FRESCO) trial.  J Am Coll Cardiol. 1998;31(6):1234-1239
PubMed   |  Link to Article
Grines CL, Cox DA, Stone GW,  et al; Stent Primary Angioplasty in Myocardial Infarction Study Group.  Coronary angioplasty with or without stent implantation for acute myocardial infarction.  N Engl J Med. 1999;341(26):1949-1956
PubMed   |  Link to Article
Gibson CM, Karha J, Murphy SA,  et al; TIMI Study Group.  Early and long-term clinical outcomes associated with reinfarction following fibrinolytic administration in the Thrombolysis in Myocardial Infarction trials.  J Am Coll Cardiol. 2003;42(1):7-16
PubMed   |  Link to Article
De Luca G, Ernst N, van 't Hof AW,  et al.  Predictors and clinical implications of early reinfarction after primary angioplasty for ST-segment elevation myocardial infarction.  Am Heart J. 2006;151(6):1256-1259
PubMed   |  Link to Article
Stettler C, Wandel S, Allemann S,  et al.  Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis.  Lancet. 2007;370(9591):937-948
PubMed   |  Link to Article
Hakeem A, Helmy T, Munsif S,  et al.  Safety and efficacy of drug eluting stents compared with bare metal stents for saphenous vein graft interventions: a comprehensive meta-analysis of randomized trials and observational studies comprising 7,994 patients.  Catheter Cardiovasc Interv. 2011;77(3):343-355
PubMed   |  Link to Article
Cortese B, Bertoletti A, De Matteis S, Danzi GB, Kastrati A. Drug-eluting stents perform better than bare metal stents in small coronary vessels: a meta-analysis of randomised and observational clinical studies with mid-term follow up [published online May 13, 2011].  Int J CardiolLink to Article
PubMed
Ma J, Yang W, Singh M, Peng T, Fang N, Wei M. Meta-analysis of long-term outcomes of drug-eluting stent implantations for chronic total coronary occlusions.  Heart Lung. 2011;40(3):e32-e40
PubMed   |  Link to Article
Piccolo R, Cassese S, Galasso G, De Rosa R, D’Anna C, Piscione F. Long-term safety and efficacy of drug-eluting stents in patients with acute myocardial infarction: a meta-analysis of randomized trials.  Atherosclerosis. 2011;217(1):149-157
PubMed   |  Link to Article
Wallace EL, Abdel-Latif A, Charnigo R, Moliterno DJ, Brodie B, Matnani R, Ziada KM. Meta-analysis of long-term outcomes for drug-eluting stents versus bare-metal stents in primary percutaneous coronary interventions for ST-segment elevation myocardial infarction [published online January 3, 2012].  Am J Cardiol
PubMed  |  Link to Article
Stone GW, Ellis SG, Colombo A,  et al.  Long-term safety and efficacy of paclitaxel-eluting stents final 5-year analysis from the TAXUS Clinical Trial Program.  JACC Cardiovasc Interv. 2011;4(5):530-542
PubMed   |  Link to Article
Stone GW, Ellis SG, Colombo A,  et al.  Offsetting impact of thrombosis and restenosis on the occurrence of death and myocardial infarction after paclitaxel-eluting and bare metal stent implantation.  Circulation. 2007;115(22):2842-2847
PubMed   |  Link to Article
Kereiakes DJ, Smits PC, Kedhi E,  et al.  Predictors of death or myocardial infarction, ischaemic-driven revascularisation, and major adverse cardiovascular events following everolimus-eluting or paclitaxel-eluting stent deployment: pooled analysis from the SPIRIT II, III, IV and COMPARE trials.  EuroIntervention. 2011;7(1):74-83
PubMed   |  Link to Article
Kimura T, Morimoto T, Kozuma K,  et al;  RESTART Investigators.  Comparisons of baseline demographics, clinical presentation, and long-term outcome among patients with early, late, and very late stent thrombosis of sirolimus-eluting stents: observations from the Registry of Stent Thrombosis for Review and Reevaluation (RESTART).  Circulation. 2010;122(1):52-61
PubMed   |  Link to Article
Windecker S, Serruys PW, Wandel S,  et al.  Biolimus-eluting stent with biodegradable polymer versus sirolimus-eluting stent with durable polymer for coronary revascularisation (LEADERS): a randomised non-inferiority trial.  Lancet. 2008;372(9644):1163-1173
PubMed   |  Link to Article
Navarese EP, Kubica J, Castriota F,  et al.  Safety and efficacy of biodegradable vs. durable polymer drug-eluting stents: evidence from a meta-analysis of randomised trials.  EuroIntervention. 2011;7(8):985-994
PubMed   |  Link to Article
Wallentin L, Becker RC, Budaj A,  et al; PLATO Investigators.  Ticagrelor versus clopidogrel in patients with acute coronary syndromes.  N Engl J Med. 2009;361(11):1045-1057
PubMed   |  Link to Article
Wiviott SD, Braunwald E, McCabe CH,  et al;  TRITON-TIMI 38 Investigators.  Prasugrel versus clopidogrel in patients with acute coronary syndromes.  N Engl J Med. 2007;357(20):2001-2015
PubMed   |  Link to Article

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