• Tullio Palmerini, Giuseppe Biondi-Zoccai, Diego Della Riva, Andrea Mariani, Manel Sabaté, Marco Valgimigli, Giacomo Frati, Elvin Kedhi, Pieter C Smits, Christoph Kaiser, Philippe Genereux, Soren Galatius, Ajay J Kirtane, and Gregg W Stone.
• Dipartimento Cardiovascolare, Policlinico Sant' Orsola, Bologna, Italy.
• J. Am. Coll. Cardiol. 2013 Aug 6;62(6):496-504.

ObjectivesThe authors investigated the relative safety and efficacy of different drug-eluting stents (DES) and bare metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI) using a network meta-analysis.BackgroundThe relative safety of DES and BMS in patients with STEMI continues to be debated, and whether advances have been made in this regard with second-generation DES is unknown.MethodsRandomized controlled trials comparing currently U.S. approved DES or DES with BMS in patients with STEMI were searched using MEDLINE, EMBASE, and Cochrane databases. Information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted.ResultsTwenty-two trials including 12,453 randomized patients were analyzed. At 1-year follow-up, cobalt-chromium everolimus eluting stents (CoCr-EES) were associated with significantly lower rates of cardiac death or myocardial infarction (MI) and stent thrombosis (ST) than BMS. Differences in ST were apparent as early as 30 days and were maintained for 2 years. CoCr-EES were also associated with significantly lower rates of 1-year ST than paclitaxel-eluting stents (PES). Sirolimus-eluting stents (SES) were also associated with significantly lower rates of 1-year cardiac death/myocardial infarction than BMS. CoCr-EES, PES, and SES, but not zotarolimus-eluting stents, had significantly lower rates of 1-year target vessel revascularization (TVR) than BMS, with SES also showing lower rates of TVR than PES.ConclusionsIn patients with STEMI, steady improvements in outcomes have been realized with the evolution from BMS to first-generation and now second-generation DES, with the most favorable safety and efficacy profile thus far demonstrated with CoCr-EES.Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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