Study Compares DES and BMS in STEMI Patients

August 5, 2013—Findings from a comprehensive network meta-analysis of the relative safety and efficacy of different drug-eluting stents (DES) and bare-metal stents (BMS) in patients with ST-elevation myocardial infarction (STEMI) were published by Tullio Palmerini, MD, et al in the Journal of the American College of Cardiology (2013;62:496–504).

The background of the study is that the relative safety of DES and BMS in patients with STEMI continues to be debated, and whether advances have been made in this regard with second-generation DES is unknown, stated the investigators.

As summarized in the Journal of the American College of Cardiology, randomized controlled trials are studying the current United States–approved DES, as well as DES compared with BMS in patients with STEMI using Medline, Embase, and Cochrane databases. The investigators extracted information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes.

The investigators analyzed 22 trials including 12,453 randomized patients. They reported that at 1-year follow-up, cobalt chromium everolimus-eluting stents (CoCr-EES) were associated with significantly lower rates of cardiac death or myocardial infarction and stent thrombosis than with BMS. Differences in stent thrombosis rates were apparent as early as 30 days and were maintained for 2 years. They also found that CoCr-EES were associated with significantly lower rates of 1-year stent thrombosis than paclitaxel-eluting stents (PES). Sirolimus-eluting stents (SES) were also associated with significantly lower rates of 1-year cardiac death/myocardial infarction than BMS. CoCr-EES, PES, and SES, but not zotarolimus-eluting stents, had significantly lower 1-year target vessel revascularization rates than BMS, with SES also showing lower rates of target vessel revascularization than PES.

The investigators concluded that in patients with STEMI, steady improvements in outcomes have been realized with the evolution from BMS to first-generation—and now second-generation—DES, with the most favorable safety and efficacy profile thus far demonstrated with CoCr-EES.