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Drug-eluting stents in acute myocardial infarction: updated meta-analysis of randomized trials

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Abstract

Background

Use of drug-eluting stents in patients with acute myocardial infarction (AMI) remains an “off label” indication due to concerns regarding their performance in this patient subset.

Methods

We searched Medline, the Cochrane Central Register of Controlled Trials, and Internet-based sources of information on clinical trials in cardiology for randomized trials comparing drug-eluting stents with bare-metal stents in patients with AMI. Hazard ratios for the composite of death or recurrent myocardial infarction, (primary safety endpoint), reintervention (primary efficacy endpoint), death, recurrent myocardial infarction, and stent thrombosis were calculated performing a meta-analysis of 14 randomized trials with 7,781 patients.

Results

There was no difference in the hazard of death or recurrent myocardial infarction (hazard ratio, 0.91; [95% CI 0.75–1.09]) between patients treated with drug-eluting stents versus patients treated with bare-metal stents. Treatment with drug-eluting stents resulted in a significant reduction in the hazard of reintervention (0.41 [95% CI 0.32–0.52]). The hazards of death (0.90 [95% CI 0.71–1.15]), myocardial infarction (0.81 [95% CI 0.63–1.04]), and stent thrombosis (0.84 [95% CI 0.61–1.17]) were not significantly different between patients treated with drug-eluting stents versus patients treated with bare-metal stents.

Conclusions

Use of drug-eluting stents in patients with AMI is safe and markedly reduces the need for reintervention as compared to bare-metal stents.

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Acknowledgments

Dr. Spaulding report having received lecture fees from Abbott, Boston Scientific, Cordis and Lilly. Dr. Laarman reports having served on the advisory board of Boston Scientific and received lecture fees from Cordis and Medtronic. Dr. Valgimigli reports having received honoraria for lectures, consultancy and research grants from Merck. Dr. Tierala reports having received unrestricted research grants via the Helsinki University Hospital Research Institute from Boston Scientific, Lilly, Roche and Sanofi-Aventis as well as lecture fees from Bristol-Myers-Squibb, Glaxo-Smith-Kline, MSD, Lilly, Sanofi-Aventis. Dr. Schalij reports having received unrestricted research grants from Biotronik, Boston Scientific and Medtronic. Dr. Kastrati reports having received lecture fees from Bristol-Myers, Biotronik, Cordis, Lilly, the Medicines, Medtronic, and Sanofi-Aventis. Drs. Dibra, Tiroch, and Kastrati had full access to and take full responsibility for the integrity of the data. All authors have read and agree to the manuscript as written.

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Authors and Affiliations

  1. Deutsches Herzzentrum, Technische Universität, Lazarettstr. 36, 80636, Munich, Germany

    Alban Dibra, Klaus Tiroch, Stefanie Schulz, Julinda Mehilli, Albert Schömig & Adnan Kastrati

  2. Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Henning Kelbæk

  3. Assistance Publique-Hôpitaux de Paris (AP-HP), Cochin Hospital, Paris 5 Medical School Rene Descartes University and INSERM U780-Avenir, Paris, France

    Christian Spaulding

  4. King’s College Hospital, London, UK

    Gerrit J. Laarman

  5. University of Ferrara, Ferrara, Italy

    Marco Valgimigli & Gianluca Campo

  6. A.O.R.N. “S. G. Moscati”, Avellino, Italy

    Emilio Di Lorenzo

  7. University of Basel, Basel, Switzerland

    Christoph Kaiser

  8. Helsinki University Central Hospital, Helsinki, Finland

    Ilkka Tierala

  9. Skejby Sygehus, Skejby, Denmark

    Leif Thuesen

  10. Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

    Maarten A. Vink

  11. Leiden University Medical Center, Leiden, The Netherlands

    Martin J. Schalij

  12. San Camillo Hospital, Rome, Italy

    Roberto Violini

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  1. Alban Dibra
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  2. Klaus Tiroch
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Correspondence to Adnan Kastrati.

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Dibra, A., Tiroch, K., Schulz, S. et al. Drug-eluting stents in acute myocardial infarction: updated meta-analysis of randomized trials. Clin Res Cardiol 99, 345–357 (2010). https://doi.org/10.1007/s00392-010-0133-y

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  • DOI: https://doi.org/10.1007/s00392-010-0133-y

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