Large Meta-Analysis Compares Second-Generation DES and BMS for Primary PCI in STEMI

November 26, 2013—Findings from a comparison of the clinical outcomes between second-generation drug-eluting stents (DES) and bare-metal stents (BMS) using a network meta-analysis of primary percutaneous coronary intervention (PCI) trials in ST-segment elevation myocardial infarction (STEMI) were published by Femi Philip, MD, et al online ahead of print in Circulation: Cardiovascular Interventions.

The investigators, who are from the Cleveland Clinic in Ohio and led by Samir R. Kapadia, MD, stated that the background of the study is that the relative safety of DES and BMS with respect to stent thrombosis continues to be debated, and there are limited data comparing safety and efficacy of second-generation DES to BMS.

According to the investigators, this network meta-analysis demonstrated a lower incidence of stent thrombosis (ST), myocardial infarction, and target vessel revascularization with second-generation DES when compared with BMS. The use of second-generation DES for PCI in STEMI was not associated with adverse events when compared with BMS, concluded the investigators.

As summarized in Circulation: Cardiovascular Interventions, randomized controlled trials comparing stent types (first-generation DES, second-generation DES, or BMS) were considered for inclusion. A search strategy used Medline, Embase, Cochrane databases, and proceedings of international meetings. Information about study design, inclusion criteria, and sample characteristics were extracted.

The investigators used network meta-analysis to pool direct (comparison of second-generation DES to BMS) and indirect evidence (first-generation DES with BMS and second-generation DES) from the randomized trials. The investigators analyzed 21 trials comparing all stent types, which included 12,866 patients randomly assigned to treatment groups.

The investigators noted a significantly lower incidence of ST with the use of second-generation DES as early as 30 days (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.15–0.82), and between 31 days and 1 year (OR, 0.49; 95% CI, 0.3–0.79) when compared with BMS. Second-generation DES were associated with a significantly lower incidence of definite ST (OR, 0.3; 95% CI, 0.11–0.83), myocardial infarction (OR, 0.3; 95% CI, 0.17–0.54), and target vessel revascularization at 1 year (OR, 0.54; 95% CI, 0.8–0.98) when compared with BMS. There was no difference in mortality at 30 days (OR, 0.84; 95% CI, 0.45–1.59) or 1 year (OR, 0.8; 95% CI, 0.56–1.14) with the use of second-generation DES versus BMS. The small number of events may influence the precision of the analysis, advised the investigators in Circulation: Cardiovascular Interventions.