Full Text:   <1345>

CLC number: R54

On-line Access: 2010-10-05

Received: 2009-09-27

Revision Accepted: 2010-03-02

Crosschecked: 2010-09-12

Cited: 10

Clicked: 4149

Citations:  Bibtex RefMan EndNote GB/T7714

-   Go to

Article info.
1. Reference List
Open peer comments

Journal of Zhejiang University SCIENCE B 2010 Vol.11 No.10 P.754-761

10.1631/jzus.B0900302


A meta-analysis of randomized trials on clinical outcomes of paclitaxel-eluting stents versus bare-metal stents in ST-segment elevation myocardial infarction patients


Author(s):  Xiao-hong Pan, Ying-xue Chen, Mei-xiang Xiang, Geng Xu, Jian-an Wang

Affiliation(s):  Department of Cardiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China

Corresponding email(s):   wja@zju.edu.cn

Key Words:  Myocardial infarction, Paclitaxel-eluting stent, Bare-metal stent, Meta-analysis


Xiao-hong Pan, Ying-xue Chen, Mei-xiang Xiang, Geng Xu, Jian-an Wang. A meta-analysis of randomized trials on clinical outcomes of paclitaxel-eluting stents versus bare-metal stents in ST-segment elevation myocardial infarction patients[J]. Journal of Zhejiang University Science B, 2010, 11(10): 754-761.

@article{title="A meta-analysis of randomized trials on clinical outcomes of paclitaxel-eluting stents versus bare-metal stents in ST-segment elevation myocardial infarction patients",
author="Xiao-hong Pan, Ying-xue Chen, Mei-xiang Xiang, Geng Xu, Jian-an Wang",
journal="Journal of Zhejiang University Science B",
volume="11",
number="10",
pages="754-761",
year="2010",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B0900302"
}

%0 Journal Article
%T A meta-analysis of randomized trials on clinical outcomes of paclitaxel-eluting stents versus bare-metal stents in ST-segment elevation myocardial infarction patients
%A Xiao-hong Pan
%A Ying-xue Chen
%A Mei-xiang Xiang
%A Geng Xu
%A Jian-an Wang
%J Journal of Zhejiang University SCIENCE B
%V 11
%N 10
%P 754-761
%@ 1673-1581
%D 2010
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B0900302

TY - JOUR
T1 - A meta-analysis of randomized trials on clinical outcomes of paclitaxel-eluting stents versus bare-metal stents in ST-segment elevation myocardial infarction patients
A1 - Xiao-hong Pan
A1 - Ying-xue Chen
A1 - Mei-xiang Xiang
A1 - Geng Xu
A1 - Jian-an Wang
J0 - Journal of Zhejiang University Science B
VL - 11
IS - 10
SP - 754
EP - 761
%@ 1673-1581
Y1 - 2010
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B0900302


Abstract: 
A meta-analysis was performed to address the efficacy and safety of paclitaxel-eluting stent (PES) in ST-segment elevation myocardial infarction (STEMI) patients. A systematic literature search was conducted to identify all randomized clinical trials in mortality, recurrent myocardial infarction (rMI), repeat revascularization (RR), and stent thrombosis (ST). A total of 4190 STEMI patients were enrolled in six randomized trials comparing PES with bare-metal stent (BMS). The pooled repeat revascularization rate was 5.7% in PES group, significantly lower than 10.0% in BMS group with an odds ratio (OR) of 0.56, 95% confidence interval (CI) [0.44, 0.72] (P<0.00001). No significant difference was found between PES and BMS groups in mortality at one year after the indexing procedure (3.9% vs. 5.1%, OR 0.88, 95% CI [0.63, 1.21], P=0.42). Similarly, rMI rate did not differ significantly between the two groups (3.4% vs. 4.1%, OR 0.80, 95% CI [0.56, 1.13], P=0.21). PES was also associated with the comparable pooled rate of definite stent thrombosis with BMS (2.3% vs. 2.4%, OR 0.81, 95% CI [0.52, 1.26], P=0.35). The results show that PES improved clinical outcomes in STEMI patients with a decreased need for repeat revascularization and no concerns for safety.

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

Reference

[1]Ad J van Boven, S.H.H., Tendera, M., Ellis, S.G., de Belder, M.A., Montalescot, G., Widimsky, P., Janssens, L., Andersen, H.R., Adamus, J., Peruga, J.Z., et al., 2007. Drug eluting stents (DES) in AMI patients. Insight from FINESSE. Circulation, 116:II_465.

[2]Brodie, B.R., Stuckey, T., Downey, W., Humphrey, A., Nussbaum, M., Laurent, S., Bradshaw, B., Metzger, C., Hermiller, J., Krainin, F., et al., 2008. Outcomes with drug-eluting stents versus bare metal stents in acute ST-elevation myocardial infarction: results from the Strategic Transcatheter Evaluation of New Therapies (STENT) Group. Catheter. Cardiovasc. Interv., 72(7):893-900.

[3]Chechi, T., Vittori, G., Biondi Zoccai, G.G., 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(4):282-291.

[4]Chen, M.S., John, J.M., Chew, D.P., Lee, D.S., Ellis, S.G., Bhatt, D.L., 2006. Bare metal stent restenosis is not a benign clinical entity. Am. Heart J., 151(6):1260-1264.

[5]Cutlip, D.E., Windecker, S., Mehran, R., Boam, A., Cohen, D.J., van Es, G.A., Steg, P.G., Morel, M.A., Mauri, L., Vranckx, P., et al., 2007. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation, 115(17):2344-2351.

[6]Daemen, J., Tanimoto, S., Garcia-Garcia, H.M., Kukreja, N., van de Sande, M., Sianos, G., de Jaegere, P.P., van Domburg, R.T., Serruys, P.W., 2007. Comparison of three-year clinical outcome of sirolimus- and paclitaxel-eluting stents versus bare-metal stents in patients with ST-segment elevation myocardial infarction (from the RESEARCH and T-SEARCH Registries). Am. J. Cardiol., 99(8):1027-1032.

[7]de Luca, G., Stone, G.W., Suryapranata, H., Laarman, G.J., Menichelli, M., Kaiser, C., Valgimigli, M., Di Lorenzo, E., Dirksen, M.T., Spaulding, C., et al., 2009a. Efficacy and safety of drug-eluting stents in ST-segment elevation myocardial infarction: a meta-analysis of randomized trials. Int. J. Cardiol., 133(2):213-222.

[8]de Luca, G., Valgimigli, M., Spaulding, C., Menichelli, M., Rocca, H.P., van der Hoeven, B.L., Di Lorenzo, E., de la Llera, L.S., Pasceri, V., Pittl, U., et al., 2009b. Short and long-term benefits of sirolimus-eluting stent in ST-segment elevation myocardial infarction: a meta-analysis of randomized trials. J. Thromb. Thrombolysis, 28(2):200-210.

[9]Di Lorenzo, E., Varricchio, A., Lanzillo, T., 2005. Paclitaxel and sirolimus stent implantation in patients with acute myocardial infarction. Circulation, 112(Suppl. II):II-478.

[10]Di Lorenzo, E., Sauro, R., Varricchio, A., Carbone, G., Cortese, G., Capasso, M., Lanzillo, T., Manganelli, F., Mariello, C., Siano, F., et al., 2009. Long-term outcome of drug-eluting stents compared with bare metal stents in ST-segment elevation myocardial infarction: results of the paclitaxel- or sirolimus-eluting stent versus bare metal stent in Primary Angioplasty (PASEO) Randomized Trial. Circulation, 120(11):964-972.

[11]Dirksen, M.T., Vink, M.A., Suttorp, M.J., Tijssen, J.G., Patterson, M.S., Slagboom, T., Kiemeneij, F., Laarman, G.J., 2008. Two-year follow-up after primary PCI with a paclitaxel-eluting stent versus a bare-metal stent for acute ST-elevation myocardial infarction (the PASSION trial): a follow-up study. EuroIntervention, 4(1):64-70.

[12]Flores-Ríos, X., Marzoa-Rivas, R., Abugattás-de Torres, J.P., Piñón-Esteban, P., Aldama-López, G., Salgado-Fernández, J., Calviño-Santos, R., Vázquez-Rodríguez, J.M., Vázquez-González, N., Castro-Beiras, A., 2007. Late thrombosis of paclitaxel-eluting stents: long-term incidence, clinical consequences, and risk factors in a cohort of 604 patients. Am. Heart J., 155(4):648-653.

[13]Grumann, T.H.J., Kersting, S., Olschewski, M., Hehrlein, C., Bode, C., 2008. Does DES save lives in ST-segment elevation myocardial infarction after 4 year clinical follow-up? Results from the Freiburg Stent Registry (FRIST). Eur. Heart J., 29(Abstract Suppl.):575.

[14]Iijima, R., Byrne, R.A., Dibra, A., Ndrepepa, G., Spaulding, C., Laarman, G.J., Menichelli, M., Valgimigli, M., Di Lorenzo, E., Kaiser, C., et al., 2009. Drug-eluting stents versus bare-metal stents in diabetic patients with ST-segment elevation acute myocardial infarction: a pooled analysis of individual patient data from seven randomized trials. Rev. Esp. Cardiol. (Engl. Ed.), 62(4):354-364.

[15]Ilkka, V.A., Tierala, M.S., HAAMU-GHOST Study Group, 2006. Randomised comparison of a paclitaxel-eluting and a bare metal stent in STEMI-PCI. The HAAMU-STENT-study. Am. J. Cardiol., 98(Suppl. 1):s78.

[16]Jaffe, R., Strauss, B.H., 2007. Late and very late thrombosis of drug-eluting stents: evolving concepts and perspectives. J. Am. Coll. Cardiol., 50(2):119-127.

[17]Kelbaek, H., Thuesen, L., Helqvist, S., Clemmensen, P., Klovgaard, L., Kaltoft, A., Andersen, B., Thuesen, H., Engstrøm, T., Bøtker, H.E., et al., 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(11):1155-1162.

[18]Laarman, G.J., Suttorp, M.J., Dirksen, M.T., van Heerebeek, L., Kiemeneij, F., Slagboom, T., van der Wieken, L.R., Tijssen, J.G., Rensing, B.J., Patterson, M., 2006. Paclitaxel-eluting versus uncoated stents in primary percutaneous coronary intervention. N. Engl. J. Med., 355(11):1105-1113.

[19]Mauri, L., Silbaugh, T.S., Garg, P., Wolf, R.E., Zelevinsky, K., Lovett, A., Varma, M.R., Zhou, Z., Normand, S.L., 2008. Drug-eluting or bare-metal stents for acute myocardial infarction. N. Engl. J. Med., 359(13):1330-1342.

[20]Moreno, R.S.C., Laarmen, G.J., Tierala, I., Kaiser, C.A., Lopez-Sendon, J.L., 2007. Effectiveness and safety of paclitaxel-eluting stents in patients with ST-segment elevation acute myocardial infarction. Eurointervention, 3:386-391.

[21]Pan, X.H., Zhong, W.Z., Xiang, M.X., Xu, G., Shan, J., Wang, J.A., 2009. Clinical outcomes of serolimus-eluting stents versus bare metal stents in ST-segment elevation myocardial infarction patients: a meta-analysis. Chin. Med. J. (Engl.), 122(1):88-92.

[22]Patel, M.R., Pfisterer, M.E., Betriu, A., Widmisky, P., Holmes, D.R.Jr., O'Neill, W.W., Stebbins, A., van de Werf, F., Armstrong, P.W., Granger, C.B., 2009. Comparison of six-month outcomes for primary percutaneous revascularization for acute myocardial infarction with drug-eluting versus bare metal stents (from the APEX-AMI study). Am. J. Cardiol., 103(2):181-186.

[23]Pittl, U., Kaiser, C., Brunner-La Rocca, H.P., 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(Abstract Suppl.):650.

[24]Silber, S., Albertsson, P., Aviles, F.F., Camici, P.G., Colombo, A., Hamm, C., Jorgensen, E., Marco, J., Nordrehaug, J.E., Ruzyllo, W., et al., 2005. Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur. Heart J., 26(8):804-847.

[25]Smith, S.C.Jr., Feldman, T.E., Hirshfeld, J.W.Jr., Jacobs, A.K., Kern, M.J., King, S.B.3rd, Morrison, D.A., O'Neil, W.W., Schaff, H.V., Whitlow, P.L., et al., 2006. ACC/AHA/ SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update 2001 Guidelines for Percutaneous Coronary Intervention). Circulation, 113(7):e166-e286.

[26]Spaulding, C., Henry, P., Teiger, E., Beatt, K., Bramucci, E., Carrie, D., Slama, M.S., Merkely, B., Erglis, A., Margheri, M., et al., 2006. Sirolimus-eluting versus uncoated stents in acute myocardial infarction. N. Engl. J. Med., 355(11):1093-1104.

[27]Stone, G.W., Lansky, A.J., Pocock, S.J., Gersh, B.J., Dangas, G., Wong, S.C., Witzenbichler, B., Guagliumi, G., Peruga, J.Z., Brodie, B.R., et al., 2009. Paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction. N. Engl. J. Med., 360(19):1946-1959.

[28]Steg, P.G., Fox, K.A., Eagle, K.A., Furman, M., van de Werf, F., Montalescot, G., Goodman, S.G., Avezum, A., Huang, W., Gore, J.M., 2009. Mortality following placement of drug-eluting and bare-metal stents for ST-segment elevation acute myocardial infarction in the Global Registry of Acute Coronary Events. Eur. Heart J., 30(3):321-329.

[29]van der Hoeven, B.L., Liem, S.S., Jukema, J.W., Suraphakdee, N., Putter, H., Dijkstra, J., Atsma, D.E., Bootsma, M., Zeppenfeld, K., Oemrawsingh, P.V., et al., 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(6):618-626.

Open peer comments: Debate/Discuss/Question/Opinion

<1>

Please provide your name, email address and a comment





Journal of Zhejiang University-SCIENCE, 38 Zheda Road, Hangzhou 310027, China
Tel: +86-571-87952783; E-mail: cjzhang@zju.edu.cn
Copyright © 2000 - Journal of Zhejiang University-SCIENCE