Stent Thrombosis With Second-Generation Drug-Eluting Stents Compared With Bare-Metal Stents
Network Meta-Analysis of Primary Percutaneous Coronary Intervention Trials in ST-Segment–Elevation Myocardial Infarction
Background—The relative safety of drug-eluting stents (DESs) and bare-metal stents (BMSs) with respect to stent thrombosis (ST) continues to be debated. There are limited data comparing safety and efficacy of second-generation DES to BMS. We compared the clinical outcomes between second-generation DES and BMS for primary percutaneous coronary intervention using network meta-analysis.
Methods and Results—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 the international meetings. Information about study design, inclusion criteria, and sample characteristics were extracted. Network meta-analysis was used 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. Twenty-one trials comparing all stents types, including 12 866 patients randomly assigned to treatment groups, were analyzed. A significantly lower incidence of ST was noted 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, 0.30–0.79) when compared with BMS. Second-generation DES was associated with significantly lower incidence of definite ST at 1 year (OR, 0.3; 95% CI, 0.11–0.83) and myocardial infarction (OR, 0.3; 95% CI, 0.17–0.54) and target vessel revascularization at 1 year (OR, 0.54; 95% CI, 0.80–0.98) 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, 0.80; 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.
Conclusions—Network meta-analysis of randomized trials of primary percutaneous coronary intervention demonstrated lower incidence of ST, myocardial infarction, and target vessel revascularization with second-generation DES when compared with BMS. The use of second-generation DES for percutaneous coronary intervention in ST-segment–elevation myocardial infarction was not associated with adverse events when compared with BMS.
- Received April 10, 2013.
- Accepted October 7, 2013.
- © 2013 American Heart Association, Inc.