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Drug-eluting stents in patients with anterior STEMI undergoing primary angioplasty: a substudy of the DESERT cooperation
- Source :
- Clinical Research in Cardiology, 103, 685-99, Clinical Research in Cardiology, 103(9), 685-699, Clinical Research in Cardiology, 103, 9, pp. 685-99
- Publication Year :
- 2014
-
Abstract
- Item does not contain fulltext BACKGROUND: Several concerns have emerged on the higher risk of in-stent thrombosis after drug-eluting stent (DES) implantation, especially in the setting of STEMI patients. Few data have even been reported in high-risk patients, such as those with anterior MI. Therefore this represents the aim of the current study. METHODS: The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL). We examined all completed randomized trials of DES for STEMI. The following key words were used for study selection: randomized trial, myocardial infarction, reperfusion, primary angioplasty, stenting, DES, sirolimus-eluting stent (SES), Cypher, paclitaxel-eluting stent (PES), Taxus. No language restrictions were enforced. RESULTS: Individual patient's data were obtained from 11 out of 13 trials, including a total of 2,782 patients with anterior MI [1,739 or 62.5 % randomized to DES and 1,043 or 37.5 % randomized to bare-metal stent (BMS)]. At long-term follow-up, no significant benefit was observed with DES as compared to BMS in terms of mortality [9.8 vs 10.9 %, HR (95 % CI) = 0.81 (0.61, 1.07), p = 0.13, p heterogeneity = 0.18], reinfarction [8.8 vs 6.4 %, respectively; HR (95 % CI) = 1.14 (0.80, 1.61), p = 0.47, p heterogeneity = 0.82], and stent thrombosis [5.6 vs 5 %, OR (95 % CI) = 0.88 (0.59, 1.30), p = 0.51, p heterogeneity = 0.65], whereas DES was associated with a significant reduction in terms of target-vessel revascularization (TVR) [13.7 vs 23.4 %; OR (95 % CI) = 0.56 (0.46, 0.69), p < 0.0001, p het = 0.81] that was observed at both early (within 1 year) [7 vs 14.7 %, HR (95 % CI) = 0.56 (0.46, 0.69), p < 0.0001, p het = 0.81] and late (>1 year) follow-up [7.2 vs 9 %, HR (95 % CI) = 0.67 (0.47, 0.96), p = 0.03, p het = 0.96]. CONCLUSIONS: This study showed that among patients with anterior STEMI undergoing primary angioplasty, SES and PES, as compared to BMS, are associated with a significant reduction in TVR at long-term follow-up. No concerns were found with the use of first-generation DES in terms of mortality.
- Subjects :
- Drug
Male
medicine.medical_specialty
Paclitaxel
media_common.quotation_subject
medicine.medical_treatment
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16]
Myocardial Infarction
Revascularization
law.invention
STEMI
Randomized controlled trial
law
Internal medicine
medicine
Humans
Myocardial infarction
media_common
STEMI, Drug-eluting stent, Primary angioplasty
Aged
Randomized Controlled Trials as Topic
Primary angioplasty
Sirolimus
business.industry
Angioplasty
Stent
Drug-Eluting Stents
Thrombosis
General Medicine
Middle Aged
medicine.disease
Treatment Outcome
Drug-eluting stent
Meta-analysis
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Subjects
Details
- Language :
- English
- ISSN :
- 18610684
- Database :
- OpenAIRE
- Journal :
- Clinical Research in Cardiology, 103, 685-99, Clinical Research in Cardiology, 103(9), 685-699, Clinical Research in Cardiology, 103, 9, pp. 685-99
- Accession number :
- edsair.doi.dedup.....32020ac4efe126b1a2e85b1c28f00cf0