TY  - JOUR
T1  - Drug-eluting vs bare-metal stents in primary angioplasty: A pooled patient-level meta-analysis of randomized trials
AU  - De Luca G, MD, PhD, Dirksen MT, MD, Spaulding C, MD, et al
Y1  - 2012/04/23
N1  - 10.1001/archinternmed.2012.758
JO  - Archives of Internal Medicine
SP  - 611
EP  - 621
VL  - 172
IS  - 8
N2  - 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.
SN  - 0003-9926
M3  - doi: 10.1001/archinternmed.2012.758
UR  - http://dx.doi.org/10.1001/archinternmed.2012.758
ER  -