Author + information
- Received June 3, 2019
- Revision received August 9, 2019
- Accepted September 3, 2019
- Published online November 18, 2019.
- Ply Chichareon, MDa,b,∗@chichareon,
- Rodrigo Modolo, MDa,c,∗@R_Modolo,
- Carlos Collet, MDa,d,
- Erhan Tenekecioglu, MDe,
- Maarten A. Vink, MD, PhDf,
- Pyung Chun Oh, MDg,
- Jung-Min Ahn, MDh,
- Carmine Musto, MD, PhDi,
- Luis S. Díaz de la Llera, MDj,
- Young-Seok Cho, MD, PhDk,
- Roberto Violini, MDi,
- Seung-Jung Park, MD, PhDh,
- Harry Suryapranata, MD, PhDl,
- Jan J. Piek, MD, PhDa,
- Robbert J. de Winter, MD, PhDa,
- Joanna J. Wykrzykowska, MD, PhDa,
- Christian Spaulding, MD, PhDm,
- Woong Chol Kang, MD, PhDg,
- Ton Slagboom, MDf,
- Sjoerd H. Hofma, MD, PhDn,
- Inge F. Wijnbergen, MD, PhDo,
- Emilio Di Lorenzo, MD, PhDp,
- Nico H. Pijls, MD, PhDo,
- Lorenz Räber, MD, PhDq,
- Salvatore Brugaletta, MD, PhDr,
- Manel Sabaté, MD, PhDr,
- Hans-Peter Stoll, MDs,
- Gregg W. Stone, MDt,
- Stephan Windecker, MDq,
- Yoshinobu Onuma, MD, PhDd,u,∗∗ ( and )
- Patrick W. Serruys, MD, PhDv,∗ ()
- aHeart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- bCardiology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- cDepartment of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP), Campinas, Brazil
- dCardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- eErasmus Medical Center, Rotterdam, the Netherlands
- fOLVG Hospital, Amsterdam, the Netherlands
- gDepartment of Cardiology, Gachon University Gil Medical Center, Incheon, South Korea
- hDepartment of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
- iInterventional Cardiology Unit-San Camillo Hospital, Rome, Italy
- jUnidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Virgen del Rocío, Seville, Spain
- kSeoul National University Bundang Hospital, Seongnam, South Korea
- lDepartment of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
- mCardiology Department, European Hospital Georges Pompidou-Assistance Publique Hôpitaux de Paris, Sudden Death Expert Center, INSERM U 970, PARCC, Paris Descartes University, Paris, France
- nMedisch Centrum Leeuwarden, Leeuwarden, the Netherlands
- oDepartment of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
- pCardiology Department, G. Moscati Hospital, Avellino, Italy
- qDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- rHospital Clinic, Institut Clinic Cardiovascular, Institut d’Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- sBiosensors Clinical Research, Morges, Switzerland
- tNew York Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
- uCardialysis Clinical Trials Management and Core Laboratories, Rotterdam, the Netherlands
- vDepartment of Cardiology, Imperial College of London, London, United Kingdom
Background To date, no specific drug-eluting stent (DES) has fully proven its superiority over others in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention.
Objectives The purpose of this study was to compare the safety and efficacy of coronary artery stents in STEMI patients in a patient-level network meta-analysis.
Methods Eligible studies were dedicated randomized controlled trials comparing different stents in STEMI patients undergoing percutaneous coronary intervention with at least 12 months of clinical follow-up. Of 19 studies identified from the published data, individual patient data were collected in 15 studies with 10,979 patients representing 87.7% of patients in the overall network of evidence. The primary endpoint was the composite of cardiac death, reinfarction, or target lesion revascularization.
Results Overall, 8,487 (77.3%) of 10,979 STEMI patients were male and the mean age was 60.7 years. At a median follow-up of 3 years, compared with bare-metal stents (BMS), patients treated with paclitaxel-, sirolimus-, everolimus-, or biolimus-eluting stents had a significantly lower risk of the primary endpoint (adjusted hazard ratios [HRs]: 0.74 [95% confidence interval (CI): 0.63 to 0.88], 0.65 [95% CI: 0.49 to 0.85], 0.70 [95% CI: 0.53 to 0.91], and 0.66 [95% CI: 0.49 to 0.88], respectively). The risk of primary endpoint was not different between patients treated with BMS and zotarolimus-eluting stents (adjusted HR: 0.83 [95% CI: 0.51 to 1.38]). Among patients treated with DES, no significant difference in the risk of the primary outcome was demonstrated. Treatment with second-generation DES was associated with significantly lower risk of definite or probable stent thrombosis compared with BMS (adjusted HR: 0.61 [95% CI: 0.42 to 0.89]) and first-generation DES (adjusted HR: 0.56 [95% CI: 0.36 to 0.88]).
Conclusions In STEMI patients, DES were superior to BMS with respect to long-term efficacy. No difference in long-term efficacy and safety was observed among specific DES. Second-generation were superior to first-generation DES in reducing stent thrombosis. (Clinical Outcomes After Primary Percutaneous Coronary Intervention [PCI] Using Contemporary Drug-Eluting Stent [DES]: Evidence From the Individual Patient Data Network Meta-Analysis; CRD42018104053)
- bare-metal stents
- drug-eluting stents
- individual patient data network meta-analysis
- ST-segment elevation myocardial infarction
↵∗ Drs. Chichareon and Modolo contributed equally to this work and are joint first authors.
This study was funded by Biosensors international. The sponsor was not involved in analysis, interpretation of data, writing of the report nor in the decision to submit the paper for publication. Drs. Chichareon, Modolo, Collet, and Tenekecioglu have received a grant from Biosensors during the conduct of the study. Dr. Collet has received grants and personal fees from Heartflow Inc.; and has received personal fees from Philips and Abbott Vascular outside of the submitted work. Dr. Piek has received nonfinancial support from Abbott Vascular; and has received personal fees and nonfinancial support from Philips/Volcano outside of the submitted work. Dr. Spaulding has received grants and personal fees from Cordis, Johnson & Johnson, during the conduct of the study; has received personal fees from Stentys, Medtronic, Abbott, and Terumo; and has received grants from Biosensors and Boston Scientific outside of the submitted work. Dr. Hofma has received unrestricted research grants from Abbott Vascular to the Research Department of the Division of Cardiology of the Medical Center Leeuwarden, during the conduct of the XAMI study. Dr. Pijls has received grants from Abbott and Hexacath; has equity in Philips, ASML, General Electric, and Heart Flow; and has received consultant fees from Boston Scientific outside of the submitted work. Dr. Räber has received grants to his institution from Abbott, Biotronik, Boston Scientific, Heartflow, Sanofi, and Regeneron; and has received speaker fees from Abbott, Amgen, AstraZeneca, CSL Behring, Sanofi, and Vifor. Dr. Sabaté has received personal fees from and served as a consultant for Abbott Vascular outside of the submitted work. Dr. Stoll is a full-time employee of Biosensors International. Dr. Stone has received personal fees from Terumo, Amaranth, Medical Development Technologies, Shockwave, Valfix, TherOx, Reva, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Matrizyme, Miracor, Neovasc, V-wave, Abiomed, Claret, Backbeat, Sirtex, Ancora, Qool Therapeutics, and SpectraWave; holds equity in Ancora, Qool Therapeutics, Cagent, Applied Therapeutics, Caliber, SpectraWave, Biostar family of funds, and MedFocus family of funds; is director of SpectraWave; and his institution, Columbia University, has received royalties from Abbott for sale of the MitraClip. Dr. Windecker has received grants from Amgen, Abbott, Boston Scientific, Bristol-Myers Squibb, Bayer, Biotronik, Edwards, Medtronic, Sinomed, and Polares outside of the submitted work. Dr. Onuma has served as a member of the Advisory Board of Abbott Vascular. Dr. Serruys has received personal fees from Abbott Laboratories, AstraZeneca, Biotronik, Cardialysis, GLG Research, Medtronic, Sino Medical Sciences Technology, Société Europa Digital Publishing, Stentys France, Svelte Medical Systems, Philips/Volcano, St. Jude Medical, Qualimed, and Xeltis outside of the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 3, 2019.
- Revision received August 9, 2019.
- Accepted September 3, 2019.
- 2019 American College of Cardiology Foundation
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