Drug-eluting stents versus bare-metal stents in acute myocardial infarction: A systematic review and meta-analysis

Hae Sun Suh, Hyun Jin Song, Ji Eun Choi, Eun Jin Jang, Hee Jeong Son, Sang Moo Lee, Jung Sun Kim, Donghoon Choi

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objectives: Recent concerns have been raised for the safety after drug-eluting stents (DES) implantation compared with the use of bare-metal stents (BMS) in patients with ST-elevation acute myocardial infarction (STEMI). The objective of this study was to estimate the relative impact of DES versus BMS on mortality, myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis (ST) in STEMI patients by performing comprehensive meta-analyses of randomized controlled trials (RCTs) and observational studies. Methods: We performed an electronic search and manual search of studies presented through September 2009, without language restrictions. An approach of "using systematic reviews" was used. Two independent reviewers extracted prespecified data from each study. A random-effects model was used to combine trials and to perform stratified analyses based on study designs and the duration of follow-up. Results: Fourteen RCTs were identified (N = 7,654). Compared with BMS, DES significantly reduced TVR (risk ratio [RR], 0.48; 95 percent confidence interval [CI], 0.41-0.56) and MI (RR, 0.77; 95 percent CI, 0.61-0.97), without increasing mortality (RR, 0.88; 95 percent CI, 0.70-1.10) and ST (RR, 0.93; 95 percent CI, 0.72-1.21). Among 35 observational studies (N = 44,849), the use of DES was associated with a significant reduction in mortality (RR, 0.85; 95 percent CI, 0.79-0.91) and TVR (RR, 0.61; 95 percent CI, 0.48-0.77). MI and ST were significantly lower in the DES group within 1-year follow-up, but there were no differences within 2 years of follow-up. There was no evidence of statistical heterogeneity and publication bias. Conclusions: These data in aggregate suggest that using DES in STEMI patients is safe and efficacious, but there are differences between RCT and observational data comparing DES and BMS.

Original languageEnglish
Pages (from-to)11-22
Number of pages12
JournalInternational Journal of Technology Assessment in Health Care
Volume27
Issue number1
DOIs
Publication statusPublished - 2011 Jan 1

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Drug-Eluting Stents
Stents
Meta-Analysis
Metals
Myocardial Infarction
Odds Ratio
Confidence Intervals
Thrombosis
Randomized Controlled Trials
Observational Studies
Mortality
Publication Bias
Language
Safety

All Science Journal Classification (ASJC) codes

  • Health Policy

Cite this

Suh, Hae Sun ; Song, Hyun Jin ; Choi, Ji Eun ; Jang, Eun Jin ; Son, Hee Jeong ; Lee, Sang Moo ; Kim, Jung Sun ; Choi, Donghoon. / Drug-eluting stents versus bare-metal stents in acute myocardial infarction : A systematic review and meta-analysis. In: International Journal of Technology Assessment in Health Care. 2011 ; Vol. 27, No. 1. pp. 11-22.
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abstract = "Objectives: Recent concerns have been raised for the safety after drug-eluting stents (DES) implantation compared with the use of bare-metal stents (BMS) in patients with ST-elevation acute myocardial infarction (STEMI). The objective of this study was to estimate the relative impact of DES versus BMS on mortality, myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis (ST) in STEMI patients by performing comprehensive meta-analyses of randomized controlled trials (RCTs) and observational studies. Methods: We performed an electronic search and manual search of studies presented through September 2009, without language restrictions. An approach of {"}using systematic reviews{"} was used. Two independent reviewers extracted prespecified data from each study. A random-effects model was used to combine trials and to perform stratified analyses based on study designs and the duration of follow-up. Results: Fourteen RCTs were identified (N = 7,654). Compared with BMS, DES significantly reduced TVR (risk ratio [RR], 0.48; 95 percent confidence interval [CI], 0.41-0.56) and MI (RR, 0.77; 95 percent CI, 0.61-0.97), without increasing mortality (RR, 0.88; 95 percent CI, 0.70-1.10) and ST (RR, 0.93; 95 percent CI, 0.72-1.21). Among 35 observational studies (N = 44,849), the use of DES was associated with a significant reduction in mortality (RR, 0.85; 95 percent CI, 0.79-0.91) and TVR (RR, 0.61; 95 percent CI, 0.48-0.77). MI and ST were significantly lower in the DES group within 1-year follow-up, but there were no differences within 2 years of follow-up. There was no evidence of statistical heterogeneity and publication bias. Conclusions: These data in aggregate suggest that using DES in STEMI patients is safe and efficacious, but there are differences between RCT and observational data comparing DES and BMS.",
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Drug-eluting stents versus bare-metal stents in acute myocardial infarction : A systematic review and meta-analysis. / Suh, Hae Sun; Song, Hyun Jin; Choi, Ji Eun; Jang, Eun Jin; Son, Hee Jeong; Lee, Sang Moo; Kim, Jung Sun; Choi, Donghoon.

In: International Journal of Technology Assessment in Health Care, Vol. 27, No. 1, 01.01.2011, p. 11-22.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Drug-eluting stents versus bare-metal stents in acute myocardial infarction

T2 - A systematic review and meta-analysis

AU - Suh, Hae Sun

AU - Song, Hyun Jin

AU - Choi, Ji Eun

AU - Jang, Eun Jin

AU - Son, Hee Jeong

AU - Lee, Sang Moo

AU - Kim, Jung Sun

AU - Choi, Donghoon

PY - 2011/1/1

Y1 - 2011/1/1

N2 - Objectives: Recent concerns have been raised for the safety after drug-eluting stents (DES) implantation compared with the use of bare-metal stents (BMS) in patients with ST-elevation acute myocardial infarction (STEMI). The objective of this study was to estimate the relative impact of DES versus BMS on mortality, myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis (ST) in STEMI patients by performing comprehensive meta-analyses of randomized controlled trials (RCTs) and observational studies. Methods: We performed an electronic search and manual search of studies presented through September 2009, without language restrictions. An approach of "using systematic reviews" was used. Two independent reviewers extracted prespecified data from each study. A random-effects model was used to combine trials and to perform stratified analyses based on study designs and the duration of follow-up. Results: Fourteen RCTs were identified (N = 7,654). Compared with BMS, DES significantly reduced TVR (risk ratio [RR], 0.48; 95 percent confidence interval [CI], 0.41-0.56) and MI (RR, 0.77; 95 percent CI, 0.61-0.97), without increasing mortality (RR, 0.88; 95 percent CI, 0.70-1.10) and ST (RR, 0.93; 95 percent CI, 0.72-1.21). Among 35 observational studies (N = 44,849), the use of DES was associated with a significant reduction in mortality (RR, 0.85; 95 percent CI, 0.79-0.91) and TVR (RR, 0.61; 95 percent CI, 0.48-0.77). MI and ST were significantly lower in the DES group within 1-year follow-up, but there were no differences within 2 years of follow-up. There was no evidence of statistical heterogeneity and publication bias. Conclusions: These data in aggregate suggest that using DES in STEMI patients is safe and efficacious, but there are differences between RCT and observational data comparing DES and BMS.

AB - Objectives: Recent concerns have been raised for the safety after drug-eluting stents (DES) implantation compared with the use of bare-metal stents (BMS) in patients with ST-elevation acute myocardial infarction (STEMI). The objective of this study was to estimate the relative impact of DES versus BMS on mortality, myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis (ST) in STEMI patients by performing comprehensive meta-analyses of randomized controlled trials (RCTs) and observational studies. Methods: We performed an electronic search and manual search of studies presented through September 2009, without language restrictions. An approach of "using systematic reviews" was used. Two independent reviewers extracted prespecified data from each study. A random-effects model was used to combine trials and to perform stratified analyses based on study designs and the duration of follow-up. Results: Fourteen RCTs were identified (N = 7,654). Compared with BMS, DES significantly reduced TVR (risk ratio [RR], 0.48; 95 percent confidence interval [CI], 0.41-0.56) and MI (RR, 0.77; 95 percent CI, 0.61-0.97), without increasing mortality (RR, 0.88; 95 percent CI, 0.70-1.10) and ST (RR, 0.93; 95 percent CI, 0.72-1.21). Among 35 observational studies (N = 44,849), the use of DES was associated with a significant reduction in mortality (RR, 0.85; 95 percent CI, 0.79-0.91) and TVR (RR, 0.61; 95 percent CI, 0.48-0.77). MI and ST were significantly lower in the DES group within 1-year follow-up, but there were no differences within 2 years of follow-up. There was no evidence of statistical heterogeneity and publication bias. Conclusions: These data in aggregate suggest that using DES in STEMI patients is safe and efficacious, but there are differences between RCT and observational data comparing DES and BMS.

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