Key result
Second-generation drug-eluting stents demonstrated a trend toward a lower incidence of stent thrombosis compared with first-generation stents in patients with acute myocardial infarction, with no significant differences in target lesion revascularization, MACEs, or all-cause death.
Why the study?
Do second-generation drug-eluting stents reduce adverse clinical outcomes compared to first-generation drug-eluting stents in patients with acute myocardial infarction?
Meta-Analysis (n=1,720)
Do second-generation drug-eluting stents reduce adverse clinical outcomes compared to first-generation drug-eluting stents in patients with acute myocardial infarction?
Answers are grounded in this paper and cite their sources.
Second-generation drug-eluting stents may offer a trend toward reduced stent thrombosis compared to first-generation stents in patients with acute myocardial infarction, though differences in MACE and mortality were not significant.
INTRODUCTION: It remains unclear whether the clinical outcomes of patients with acute myocardial infarction (AMI) receiving second- and first-generation drug-eluting stents (DES) are identical. The study aimed to investigate the differences in clinical utility between the two generations of DES in these specific subjects by a meta-analysis. MATERIAL AND METHODS: We systemically searched PubMed and EMBASE databases and the Cochrane Library up until January 2013. Randomized trials, which compared clinical outcomes of second-generation DES (everolimus- (EES) or zotarolimus-eluting stents (ZES)) with first-generation DES (sirolimus- or paclitaxel-eluting stents) in patients with AMI were included. RESULTS: Five trials with 1720 AMI subjects were included in the meta-analysis. Pooled analysis demonstrated a trend toward lower incidence of stent thrombosis with the second-generation DES relative to the first-generation one (risk ratio (RR), 0.53; 95% confidence intervals (CI): 0.25-1.13; p = 0.10). However, the second-generation DES did not offer a significant advantage over the first-generation DES in reducing the incidence of target lesion revascularization (TLR) (RR = 1.73; 95% CI: 0.83-3.64; p = 0.15), major adverse cardiac events (MACEs) (RR = 0.97; p = 0.90), or all-cause death (RR = 1.00; p = 1.0). In addition, in elderly patients the second-generation DES seemed to reduce the occurrence of MACEs (RR = 0.65; p = 0.10) and stent thrombosis (RR = 0.40; p = 0.08), and the second-generation EES showed a potential benefit in lowering the MACE rate (RR = 0.55; p = 0.06). CONCLUSIONS: The second-generation DES appeared to lower the risk of stent thrombosis in AMI patients. There might be a lower incidence of MACEs associated with the second-generation EES.
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Wu et al. (2014) conducted a meta-analysis in Acute myocardial infarction (n=1,720). Second-generation drug-eluting stents (everolimus or zotarolimus) vs. First-generation drug-eluting stents (sirolimus or paclitaxel) was evaluated on Stent thrombosis (RR 0.53, 95% CI 0.25-1.13, p=0.10). Second-generation drug-eluting stents demonstrated a trend toward a lower incidence of stent thrombosis compared with first-generation stents in patients with acute myocardial infarction, with no significant differences in target lesion revascularization, MACEs, or all-cause death.
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