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01.06.2010 | Review

Drug-eluting stents in acute myocardial infarction: updated meta-analysis of randomized trials

verfasst von: Alban Dibra, Klaus Tiroch, Stefanie Schulz, Henning Kelbæk, Christian Spaulding, Gerrit J. Laarman, Marco Valgimigli, Emilio Di Lorenzo, Christoph Kaiser, Ilkka Tierala, Julinda Mehilli, Gianluca Campo, Leif Thuesen, Maarten A. Vink, Martin J. Schalij, Roberto Violini, Albert Schömig, Adnan Kastrati

Erschienen in: Clinical Research in Cardiology | Ausgabe 6/2010

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Abstract

Background

Use of drug-eluting stents in patients with acute myocardial infarction (AMI) remains an “off label” indication due to concerns regarding their performance in this patient subset.

Methods

We searched Medline, the Cochrane Central Register of Controlled Trials, and Internet-based sources of information on clinical trials in cardiology for randomized trials comparing drug-eluting stents with bare-metal stents in patients with AMI. Hazard ratios for the composite of death or recurrent myocardial infarction, (primary safety endpoint), reintervention (primary efficacy endpoint), death, recurrent myocardial infarction, and stent thrombosis were calculated performing a meta-analysis of 14 randomized trials with 7,781 patients.

Results

There was no difference in the hazard of death or recurrent myocardial infarction (hazard ratio, 0.91; [95% CI 0.75–1.09]) between patients treated with drug-eluting stents versus patients treated with bare-metal stents. Treatment with drug-eluting stents resulted in a significant reduction in the hazard of reintervention (0.41 [95% CI 0.32–0.52]). The hazards of death (0.90 [95% CI 0.71–1.15]), myocardial infarction (0.81 [95% CI 0.63–1.04]), and stent thrombosis (0.84 [95% CI 0.61–1.17]) were not significantly different between patients treated with drug-eluting stents versus patients treated with bare-metal stents.

Conclusions

Use of drug-eluting stents in patients with AMI is safe and markedly reduces the need for reintervention as compared to bare-metal stents.

Altman DG, Schulz KF (2001) Statistics notes: concealing treatment allocation in randomised trials. BMJ 323:446–447CrossRefPubMed

Bauer T, Hoffmann R, Junger C, Koeth O, Zahn R, Gitt A, Heer T, Bestehorn K, Senges J, Zeymer U (2009) Efficacy of a 24-h primary percutaneous coronary intervention service on outcome in patients with ST elevation myocardial infarction in clinical practice. Clin Res Cardiol 98:171–178CrossRefPubMed

Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101CrossRefPubMed

Chechi T, Vittori G, Biondi Zoccai GG, Vecchio S, Falchetti E, Spaziani G, Baldereschi G, Giglioli C, Valente S, Margheri M (2007) Single-center randomized evaluation of paclitaxel-eluting versus conventional stent in acute myocardial infarction (SELECTION). J Interv Cardiol 20:282–291CrossRefPubMed

Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Steg PG, Morel MA, Mauri L, Vranckx P, McFadden E, Lansky A, Hamon M, Krucoff MW, Serruys PW (2007) Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115:2344–2351CrossRefPubMed

Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger C, Kukreja N, Juni P, Sianos G, Hellige G, van Domburg RT, Hess OM, Boersma E, Meier B, Windecker S, Serruys PW (2007) Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet 369:667–678CrossRefPubMed

De Luca G, Stone GW, Suryapranata H, Laarman GJ, Menichelli M, Kaiser C, Valgimigli M, Di Lorenzo E, Dirksen MT, Spaulding C, Pittl U, Violini R, Percoco G, Marino P (2008) Efficacy and safety of drug-eluting stents in ST-segment elevation myocardial infarction: a meta-analysis of randomized trials. Int J Cardiol. doi:10.1016/j.ijcard.2007.12.040

De Luca G, Suryapranata H, Stone GW, Antoniucci D, Biondi-Zoccai G, Kastrati A, Chiariello M, Marino P (2008) Coronary stenting versus balloon angioplasty for acute myocardial infarction: a meta-regression analysis of randomized trials. Int J Cardiol 126:37–44CrossRefPubMed

DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188CrossRefPubMed

10.

Di Lorenzo E, Varricchio A, Lanzillo T, Sauro R, Cianciulli GM, Manganelli F, Mariello C, Siano F, Pagliuca MP, Stanco G, Rosato G (2005) Paclitaxel and sirolimus stent implantation in patients with acute myocardial infarction. Circulation 112:U538–U538 Abstract

11.

Diaz de la Llera LS, Ballesteros S, Nevado J, Fernandez M, Villa M, Sanchez A, Retegui G, Garcia D, Martinez A (2007) Sirolimus-eluting stents compared with standard stents in the treatment of patients with primary angioplasty. Am Heart J 154(1):164 e161–166

12.

Dibra A, Kastrati A, Alfonso F, Seyfarth M, Perez-Vizcayno MJ, Mehilli J, Schömig A (2007) Effectiveness of drug-eluting stents in patients with bare-metal in-stent restenosis: meta-analysis of randomized trials. J Am Coll Cardiol 49:616–623CrossRefPubMed

13.

Grines CL, Cox DA, Stone GW, Garcia E, Mattos LA, Giambartolomei A, Brodie BR, Madonna O, Eijgelshoven M, Lansky AJ, O’Neill WW, Morice MC (1999) Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med 341:1949–1956CrossRefPubMed

14.

Helsinki Area Acute Myocardial Infarction Treatment Re-Evaluation—Should the Patients Get a Drug-Eluting or Normal Stent (HAAMU-STENT) trial. Available at http://wwwtct2006com/Dailies_TCT2006/tuesday_fulltext/Paclitaxel_Stent_Had_Wider_Lumen_in_Acute_MI_Patientshtml. Accessed January 31, 2010

15.

Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560CrossRefPubMed

16.

Hoffmann R, Klinker H, Adamu U, Kelm M, Blindt R (2009) The risk of definitive stent thrombosis is increased after “off-label” stent implantation irrespective of drug-eluting stent or bare-metal stent use. Clin Res Cardiol 98:549–554CrossRefPubMed

17.

Juni P, Altman DG, Egger M (2001) Systematic reviews in health care: assessing the quality of controlled clinical trials. BMJ 323:42–46CrossRefPubMed

18.

Karjalainen PP, Ylitalo A, Niemelä M, Kervinen K, Mäkikallio T, Pietilä M, Sia J, Tuomainen M, Nyman K, Airaksinen KE (2008) Titanium-nitride-oxide coated stents versus paclitaxel-eluting stents in acute myocardial infarction: a 12-months follow-up report from the TITAX AMI trial. EuroInterv 4:234–241

19.

Kastrati A, Dibra A, Spaulding C, Laarman GJ, Menichelli M, Valgimigli M, Di Lorenzo E, Kaiser C, Tierala I, Mehilli J, Seyfarth M, Varenne O, Dirksen MT, Percoco G, Varricchio A, Pittl U, Syvanne M, Suttorp MJ, Violini R, Schomig A (2007) Meta-analysis of randomized trials on drug-eluting stents vs. bare-metal stents in patients with acute myocardial infarction. Eur Heart J 28:2706–2713CrossRefPubMed

20.

Kastrati A, Mehilli J, Pache J, Kaiser C, Valgimigli M, Kelbaek H, Menichelli M, Sabate M, Suttorp MJ, Baumgart D, Seyfarth M, Pfisterer ME, Schömig A (2007) Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med 356:1030–1039CrossRefPubMed

21.

Kelbaek H, Thuesen L, Helqvist S, Clemmensen P, Klovgaard L, Kaltoft A, Andersen B, Thuesen H, Engstrom T, Botker HE, Saunamaki K, Krusell LR, Jorgensen E, Hansen HH, Christiansen EH, Ravkilde J, Kober L, Kofoed KF, Terkelsen CJ, Lassen JF (2008) Drug-eluting versus bare-metal stents in patients with st-segment-elevation myocardial infarction: eight-month follow-up in the Drug Elution and Distal Protection in Acute Myocardial Infarction (DEDICATION) trial. Circulation 118:1155–1162CrossRefPubMed

22.

Khattab AA, Abdel-Wahab M, Rother C, Liska B, Toelg R, Kassner G, Geist V, Richardt G (2008) Multi-vessel stenting during primary percutaneous coronary intervention for acute myocardial infarction. A single-center experience. Clin Res Cardiol 97:32–38CrossRefPubMed

23.

Koeth O, Bauer T, Wienbergen H, Gitt AK, Juenger C, Zeymer U, Hauptmann KE, Glunz HG, Sechtem U, Senges J, Zahn R (2009) Angioplasty within 24 h after thrombolysis in patients with acute ST-elevation myocardial infarction: current use, predictors and outcome. Results of the MITRA plus registry. Clin Res Cardiol 98:107–113CrossRefPubMed

24.

Kukreja N, Onuma Y, Garcia-Garcia H, Daemen J, Van Domburg RT, Serruys PW (2008) Primary percutaneous coronary intervention for acute myocardial infarction Long-term outcome after bare metal and drug-eluting stent implantation. Circ Cardiovasc Intervent 1:103–110CrossRef

25.

Laarman GJ, Suttorp MJ, Dirksen MT, van Heerebeek L, Kiemeneij F, Slagboom T, van der Wieken LR, Tijssen JGP, Rensing BJ, Patterson M (2006) Paclitaxel-eluting versus uncoated stents in primary percutaneous coronary intervention. N Engl J Med 55:1105–1113CrossRef

26.

Lemos PA, Saia F, Hofma SH, Daemen J, Ong AT, Arampatzis CA, Hoye A, McFadden E, Sianos G, Smits PC, van der Giessen WJ, de Feyter P, van Domburg RT, Serruys PW (2004) Short- and long-term clinical benefit of sirolimus-eluting stents compared to conventional bare stents for patients with acute myocardial infarction. J Am Coll Cardiol 43:704–708CrossRefPubMed

27.

Luscher TF, Steffel J, Eberli FR, Joner M, Nakazawa G, Tanner FC, Virmani R (2007) Drug-eluting stent and coronary thrombosis: biological mechanisms and clinical implications. Circulation 115:1051–1058CrossRefPubMed

28.

Maillard L, Hamon M, Khalife K, Steg PG, Beygui F, Guermonprez JL, Spaulding CM, Boulenc JM, Lipiecki J, Lafont A, Brunel P, Grollier G, Koning R, Coste P, Favereau X, Lancelin B, Van Belle E, Serruys P, Monassier JP, Raynaud P (2000) A comparison of systematic stenting and conventional balloon angioplasty during primary percutaneous transluminal coronary angioplasty for acute myocardial infarction. STENTIM-2 Investigators. J Am Coll Cardiol 35:1729–1736CrossRefPubMed

29.

Mauri L, Silbaugh TS, Garg P, Wolf RE, Zelevinsky K, Lovett A, Varma MR, Zhou Z, Normand SL (2008) Drug-eluting or bare-metal stents for acute myocardial infarction. N Engl J Med 359:1330–1342CrossRefPubMed

30.

Menichelli M, Parma A, Pucci E, Fiorilli R, De Felice F, Nazzaro M, Giulivi A, Alborino D, Azzellino A, Violini R (2007) Randomized trial of sirolimus-eluting stent versus bare-metal stent in acute myocardial infarction (SESAMI). J Am Coll Cardiol 49:1924–1930CrossRefPubMed

31.

Nakazawa G, Finn AV, Joner M, Ladich E, Kutys R, Mont EK, Gold HK, Burke AP, Kolodgie FD, Virmani R (2008) Delayed arterial healing and increased late stent thrombosis at culprit sites after drug-eluting stent placement for acute myocardial infarction patients: an autopsy study. Circulation 118:1138–1145CrossRefPubMed

32.

Ndrepepa G, Keta D, Schulz S, Byrne RA, Mehilli J, Pache J, Seyfarth M, Schomig A, Kastrati A (2009) Prognostic value of minimal blood flow restoration in patients with acute myocardial infarction after reperfusion therapy. Clin Res Cardiol 99:13–19CrossRefPubMed

33.

Newell MC, Henry CR, Sigakis CJ, Unger BT, Larson DM, Chavez IJ, Burke MN, Traverse JH, Henry TD (2006) Comparison of safety and efficacy of sirolimus-eluting stents versus bare-metal stents in patients with ST-segment elevation myocardial infarction. Am J Cardiol 97:1299–1302CrossRefPubMed

34.

Nordmann AJ, Bucher H, Hengstler P, Harr T, Young J (2005) Primary stenting versus primary balloon angioplasty for treating acute myocardial infarction. Cochrane Database Syst Rev:CD005313

35.

Park DW, Park SW, Park KH, Lee BK, Kim YH, Lee CW, Hong MK, Kim JJ, Park SJ (2006) Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up. Am J Cardiol 98:352–356CrossRefPubMed

36.

Pasceri V, Granatelli A, Pristipino C, Pelliccia F, Speciale G, Pironi B, Roncella A, Richichi G (2003) A randomized trial of a rapamycin-eluting stent in acute myocardial infarction: preliminary results. Am J Cardiol 92:1 (Abstract)

37.

Pasceri V, Patti G, Speciale G, Pristipino C, Richichi G, Di Sciascio G (2007) Meta-analysis of clinical trials on use of drug-eluting stents for treatment of acute myocardial infarction. Am Heart J 153:749–754CrossRefPubMed

38.

Percoco G, Manari A, Guastaroba P, Campo G, Guiducci V, Aurier E, Sangiorgio P, Passerini F, Geraci G, Piovaccari G, Naldi M, Saia F, Marzocchi A (2006) Safety and long-term efficacy of sirolimus eluting stent in ST-elevation acute myocardial infarction: the REAL (Registro REgionale AngiopLastiche Emilia-Romagna) registry. Cardiovasc Drugs Ther 20:63–68CrossRefPubMed

39.

Pfisterer ME (2008) Late stent thrombosis after drug-eluting stent implantation for acute myocardial infarction: a new red flag is raised. Circulation 118:1117–1119CrossRefPubMed

40.

Pittl U, Kaiser C, Brunner-La Rocca HP, Hunziker P, Linka AZ, Osswald S, Buser PT, Pfisterer ME (2006) Safety and efficacy of drug eluting stents versus bare-metal stents in primary angioplasty of patients with acute ST-elevation myocardial infarction - a prospective randomized study. Eur Heart J 27:650 (Abstract)

41.

Sianos G, Papafaklis MI, Daemen J, Vaina S, van Mieghem CA, van Domburg RT, Michalis LK, Serruys PW (2007) Angiographic stent thrombosis after routine use of drug-eluting stents in ST-segment elevation myocardial infarction: the importance of thrombus burden. J Am Coll Cardiol 50:573–583CrossRefPubMed

42.

Spaulding C, Henry P, Teiger E, Beatt K, Bramucci E, Carrie D, Slama MS, Merkely B, Erglis A, Margheri M, Varenne O, Cebrian A, Stoll HP, Snead DB, Bode C, for the TYPHOON Investigators (2006) Sirolimus-eluting versus uncoated stents in acute myocardial infarction. N Engl J Med 55:1093–1104CrossRef

43.

Stettler C, Allemann S, Wandel S, Kastrati A, Morice MC, Schomig A, Pfisterer ME, Stone GW, Leon MB, de Lezo JS, Goy JJ, Park SJ, Sabate M, Suttorp MJ, Kelbaek H, Spaulding C, Menichelli M, Vermeersch P, Dirksen MT, Cervinka P, De Carlo M, Erglis A, Chechi T, Ortolani P, Schalij MJ, Diem P, Meier B, Windecker S, Juni P (2008) Drug eluting and bare-metal stents in people with and without diabetes: collaborative network meta-analysis. BMJ 337:a1331CrossRefPubMed

44.

Stone GW, Grines CL, Cox DA, Garcia E, Tcheng JE, Griffin JJ, Guagliumi G, Stuckey T, Turco M, Carroll JD, Rutherford BD, Lansky AJ (2002) Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. N Engl J Med 346:957–966CrossRefPubMed

45.

Stone GW, Lansky AJ, Pocock SJ, Gersh BJ, Dangas G, Wong SC, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Mockel M, Ochala A, Kellock A, Parise H, Mehran R (2009) Paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction. N Engl J Med 360:1946–1959CrossRefPubMed

46.

Suryapranata H, De Luca G, van ‘t Hof AW, Ottervanger JP, Hoorntje JC, Dambrink JH, Gosselink AT, Zijlstra F, de Boer MJ (2005) Is routine stenting for acute myocardial infarction superior to balloon angioplasty? A randomised comparison in a large cohort of unselected patients. Heart 91:641–645CrossRefPubMed

47.

US FDA/CDRH. Update to FDA statement of coronary drug-eluting stents. January 4, 2007. Available at: http://wwwfdagov/cdrh/news/010407html. Accessed 31 Jan 2010

48.

Valgimigli M, Campo G, Percoco G, Bolognese L, Vassanelli C, Colangelo S, de Cesare N, Rodriguez AE, Ferrario M, Moreno R, Piva T, Sheiban I, Pasquetto G, Prati F, Nazzaro MS, Parrinello G, Ferrari R (2008) Comparison of angioplasty with infusion of tirofiban or abciximab and with implantation of sirolimus-eluting or uncoated stents for acute myocardial infarction: the MULTISTRATEGY randomized trial. JAMA 299:1788–1799CrossRefPubMed

49.

Valgimigli M, Percoco G, Malagutti P, Campo G, Ferrari F, Barbieri D, Cicchitelli G, McFadden EP, Merlini F, Ansani L, Guardigli G, Bettini A, Parrinello G, Boersma E, Ferrari R (2005) Tirofiban and sirolimus-eluting stent vs abciximab and bare-metal stent for acute myocardial infarction: a randomized trial. JAMA 293:2109–2117CrossRefPubMed

50.

van der Hoeven BL, Liem SS, Jukema JW, Suraphakdee N, Putter H, Dijkstra J, Atsma DE, Bootsma M, Zeppenfeld K, Oemrawsingh PV, van der Wall EE, Schalij MJ (2008) Sirolimus-eluting stents versus bare-metal stents in patients with ST-segment elevation myocardial infarction: 9-month angiographic and intravascular ultrasound results and 12-month clinical outcome results from the MISSION! Intervention Study. J Am Coll Cardiol 51:618–626CrossRefPubMed

51.

Zhu MM, Feit A, Chadow H, Alam M, Kwan T, Clark LT (2001) Primary stent implantation compared with primary balloon angioplasty for acute myocardial infarction: a meta-analysis of randomized clinical trials. Am J Cardiol 88:297–301CrossRefPubMed

Titel: Drug-eluting stents in acute myocardial infarction: updated meta-analysis of randomized trials
verfasst von: Alban Dibra
Klaus Tiroch
Stefanie Schulz
Henning Kelbæk
Christian Spaulding
Gerrit J. Laarman
Marco Valgimigli
Emilio Di Lorenzo
Christoph Kaiser
Ilkka Tierala
Julinda Mehilli
Gianluca Campo
Leif Thuesen
Maarten A. Vink
Martin J. Schalij
Roberto Violini
Albert Schömig
Adnan Kastrati
Publikationsdatum: 01.06.2010
Verlag: Springer-Verlag
Erschienen in: Clinical Research in Cardiology / Ausgabe 6/2010
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-010-0133-y

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