Very late stent thrombosis with second generation drug eluting stents compared to bare metal stents: Network meta-analysis of randomized primary percutaneous coronary intervention trials

• Published in: Catheterization and cardiovascular interventions Vol. 88; no. 1; pp. 38 - 48
• Main Authors: Philip, Femi, Stewart, Susan, Southard, Jeffrey A.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.07.2016; Wiley Subscription Services, Inc
• Subjects: acute myocardial infarction; Coronary Thrombosis - diagnosis; Coronary Thrombosis - etiology; Coronary Thrombosis - mortality; Coronary Thrombosis - therapy; drug-eluting stent; Drug-Eluting Stents; Humans; Metals; Network Meta-Analysis; Odds Ratio; percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - mortality; Prosthesis Design; Randomized Controlled Trials as Topic; Recurrence; Retreatment; Risk Factors; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - mortality; ST Elevation Myocardial Infarction - therapy; Stents; Stroke - etiology; Time Factors; Treatment Outcome; percutaneous coronary intervention; acute myocardial infarction; drug-eluting stent
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.26458

Background The relative safety of drug‐eluting stents (DES) and bare‐metal stents (BMS) in primary percutaneous coronary intervention (PPCI) in ST elevation myocardial infarction (STEMI) continues to be debated. The long‐term clinical outcomes between second generation DES and BMS for primary percutaneous coronary intervention (PCI) using network meta‐analysis were compared. Methods: 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. 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. Results: Twelve trials comparing all stents types including 9,673 patients randomly assigned to treatment groups were analyzed. Second generation DES was associated with significantly lower incidence of definite or probable ST (OR 0.59, 95% CI 0.39–0.89), MI (OR 0.59, 95% CI 0.39–0.89), and TVR at 3 years (OR 0.50: 95% CI 0.31–0.81) compared with BMS. In addition, there was a significantly lower incidence of MACE with second generation DES versus BMS (OR 0.54, 95% CI 0.34–0.74) at 3 years. These were driven by a higher rate of TVR, MI and stent thrombosis in the BMS group at 3 years. There was a non‐significant reduction in the overall and cardiac mortality [OR 0.83, 95% CI (0.60–1.14), OR 0.88, 95% CI (0.6–1.28)] with the use of second generation DES versus BMS at 3 years. Conclusions: Network meta‐analysis of randomized trials of primary PCI demonstrated lower incidence of MACE, MI, TVR, and stent thrombosis with second generation DES compared with BMS. © 2016 Wiley Periodicals, Inc.