Comparison of Newer-Generation Drug-Eluting With Bare-Metal Stents in聽Patients With Acute ST-Segment Elevation Myocardial Infarction: A Pooled Analysis of the EXAMINATION (clinical Evaluation of the Xience-V stent聽in Acute Myocardial INfArcTION) and COMFORTABLE-AMI (Comparison of聽Biolimus Eluted From an Erodible Stent Coating With Bare Metal Ste

详细信息    查看全文

• 作者：Manel Sabat茅 ; Lorenz R盲ber ; Dik Heg ; Salvatore Brugaletta ; Henning Kelbaek ; Angel Cequier ; Miodrag Ostojic ; Andr茅s I帽iguez ; David T眉ller ; Antonio Serra ; Andreas Baumbach ; Clemens von Birgelen ; Rosana Hern ; ez-Antolin ; Marco Roffi ; Vicente Mainar ; Marco Valgimigli ; Patrick W. Serruys ; Peter J眉ni ; Stephan Windecker
• 关键词：drug-eluting stent(s) ; STEMI ; stent thrombosis
• 刊名：JACC: Cardiovascular Interventions
• 出版年：January, 2014
• 年：2014
• 卷：7
• 期：1
• 页码：55-63
• 全文大小：1440 K

文摘

| Figures/TablesFigures/Tables | ReferencesReferences

Objectives

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).

Background

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.

Methods

Individual patient data for 2,665 STEMI patients enrolled in 2 large-scale randomized clinical聽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.

Results

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聽0.79; p聽= 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聽= 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:聽0.14 to 0.92; p聽= 0.03). Newer-generation DES also reduced the risk of definite stent thrombosis (RR: 0.35; 95% CI: 0.16 to 0.75; p聽= 0.006) compared with BMS.

Conclusions

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.