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Comparison of Newer-Generation Drug-Eluting Stents With Bare-Metal Stents in Patients With Acute ST-Segment Elevation Myocardial Infarction: A Pooled Analysis of the EXAMINATION (clinical Evaluation of the Xience-V stent in Acute Myocardial INfArcTION) and COMFORTABLE-AMI (Com-parison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction) Trials.
MedLine Citation:
PMID:  24332419     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: This study sought to study the efficacy and safety of newer-generation drug-eluting stents (DESs) compared with bare-metal stents (BMSs) in an appropriately powered population of patients with ST-segment elevation myocardial infarction (STEMI).
BACKGROUND: Among patients with STEMI, early generation DESs improved efficacy but not safety compared with BMSs. Newer-generation DESs, everolimus-eluting stents, and biolimus A9-eluting stents, have been shown to improve clinical outcomes compared with early generation DESs.
METHODS: Individual patient data for 2,665 STEMI patients enrolled in 2 large-scale randomized clinical trials comparing newer-generation DESs with BMSs were pooled: 1,326 patients received a newer-generation DES (everolimus-eluting stent or biolimus A9-eluting stent), whereas the remaining 1,329 patients received a BMS. Random-effects models were used to assess differences between the 2 groups for the device-oriented composite endpoint of cardiac death, target-vessel reinfarction, and target-lesion revascularization and the patient-oriented composite endpoint of all-cause death, any infarction, and any revascularization at 1 year.
RESULTS: Newer-generation DESs substantially reduce the risk of the device-oriented composite endpoint compared with BMSs at 1 year (relative risk [RR]: 0.58; 95% confidence interval [CI]: 0.43 to 0.79; p = 0.0004). Similarly, the risk of the patient-oriented composite endpoint was lower with newer-generation DESs than BMSs (RR: 0.78; 95% CI: 0.63 to 0.96; p = 0.02). Differences in favor of newer-generation DESs were driven by both a lower risk of repeat revascularization of the target lesion (RR: 0.33; 95% CI: 0.20 to 0.52; p < 0.0001) and a lower risk of target-vessel infarction (RR: 0.36; 95% CI: 0.14 to 0.92; p = 0.03). Newer-generation DESs also reduced the risk of definite stent thrombosis (RR: 0.35; 95% CI: 0.16 to 0.75; p = 0.006) compared with BMSs.
CONCLUSIONS: Among patients with STEMI, newer-generation DESs improve safety and efficacy compared with BMSs throughout 1 year. It remains to be determined whether the differences in favor of newer-generation DESs are sustained during long-term follow-up.
Authors:
Manel Sabaté; Lorenz Räber; Dik Heg; Salvatore Brugaletta; Henning Kelbaek; Angel Cequier; Miodrag Ostojic; Andrés Iñiguez; David Tüller; Antonio Serra; Andreas Baumbach; Clemens von Birgelen; Rosana Hernandez-Antolin; Marco Roffi; Vicente Mainar; Marco Valgimigli; Patrick W Serruys; Peter Jüni; Stephan Windecker
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-12-5
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  -     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2013 Dec 
Date Detail:
Created Date:  2013-12-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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