• Fei Zheng, Shanshan Xing, Zushun Gong, and Qichong Xing.
• Department of Cardiology, Qianfoshan Hospital, Shandong University, PR China.
• Heart Lung Circ. 2014 Jun 1; 23 (6): 542-8.

BackgroundDrug-eluting stent (DES) implantation has been proved more effective compared with bare-metal stent (BMS) implantation for ST-segment elevation myocardial infarction (STEMI) within medium follow up. However, limited information is available on the long-term safety and efficacy of DES.MethodsWe performed a meta-analysis of randomised controlled trials (RCT) comparing DES with BMS in patients with STEMI at long-term follow up, defined as five years or more. The clinical end points were target vessel revascularisation (TVR), death, recurrent myocardial infarction (MI), stent thrombosis and very late stent thrombosis. We calculated the pooled estimate based on a fixed-effects model using odds ratio (OR) for rare events.ResultsFour RCT were included, with a total of 1414 patients enrolled. Up to five years, DES showed a significant reduction in TVR (OR, 0.55; 95% confidence interval [CI], 0.55-0.77; P = 0.0005), but an increase in very late stent thrombosis (OR, 3.03; 95% CI, 1.28-7.18; P = 0.01), without increasing mortality (OR, 0.85; 95% CI, 0.59-1.20; P = 0.35), recurrent MI (OR, 1.05; 95% CI, 0.69-1.60; P = 0.80), and overall stent thrombosis (OR, 1.10; 95% CI, 0.66-1.82; P = 0.72).ConclusionsAt long-term follow-up, primary percutaneous coronary intervention with DES improved efficacy, without reducing overall safety. However, a trade-off must be made between the reduction of reintervention with DES and an increase in very late stent thrombosis.Crown Copyright © 2014. Published by Elsevier B.V. All rights reserved.

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