Background: Drug-eluting stents (DES) are associated with a decreased frequency of repeat revascularization compared with bare metal stents (BMS) in patients with coronary artery disease; however, uncertainty over their long-term safety, especially in high-risk patients, such as those with ST elevation myocardial infarction (STEMI), persists.
Objective: To evaluate the safety and efficacy of DES compared with BMS in STEMI patients at a follow-up of three years or longer.
Methods: Two independent investigators systematically searched the Medline, CENTRAL, Embase and CardioSource databases for randomized trials comparing DES with BMS in STEMI, and reporting outcomes at three years or longer. Relevant study characteristics and clinical end points were extracted. Random-effect and fixed-effect models were used to calculate ORs for heterogeneous and homogenous outcomes, respectively.
Results: Ten randomized trials met the eligibility criteria, resulting in the inclusion of 4330 patients in the DES group and 2662 patients in the BMS group. DES use significantly reduced the odds of target vessel (OR 0.44 [95% CI 0.35 to 0.54]) and target lesion revascularization (OR 0.47 [95% CI 0.36 to 0.61]). Furthermore, patients in the DES group experienced major adverse coronary events less frequently than patients in the BMS group, which was driven mainly by the decreased revascularization rate. Although the incidence of stent thrombosis was similar, DES was associated with a higher risk of very late stent thrombosis (OR 1.69 [95% CI 1.11 to 2.57]). There were no differences between the groups with respect to death, cardiac death and myocardial infarction.
Conclusion: DES continues to be associated with a lower repeat revascularization rate in patients with STEMI, with a small but significantly increased risk of very late stent thrombosis compared with BMS at a follow-up of three years or longer.
Keywords: Bare metal stent; Drug eluting stent, Primary percutaneous coronary intervention; ST elevation; Stent thrombosis.