Long-term safety and efficacy of drug-eluting stents in patients with acute myocardial infarction: a meta-analysis of randomized trials

Background: Despite short-term outcomes of patients with ST-segment elevation myocardial infarction (STEMI) indicate a benefit of DES in terms of reintervention, limited information is available on the long-term safety and efficacy of DES in these patients. Our aim was to perform a meta-analysis of randomized trials evaluating the long-term outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients with STEMI.

Methods and results: A systematic literature search of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, scientific session abstracts and relevant websites, through September 2010, was performed using specific search terms. Included trials were randomized studies comparing DES to BMS in patients presenting with STEMI, with a follow-up ≥ 3 years. Ten of the 1496 studies initially identified met inclusion criteria, with a total of 6774 patients enrolled. At a mean follow-up of 3.6 years, DES significantly reduced target-vessel revascularization compared with BMS (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.43-0.59; p<0.0001), without increasing mortality (OR, 0.88; 95% CI, 0.72-1.06; p=0.18), reinfarction (OR, 1.02; 95% CI, 0.81-1.27; p=0.88) and overall stent thrombosis (OR, 1.06; 95% CI, 0.83-1.35; p=0.66). Very late stent thrombosis, occurring 1 year after revascularization, was significantly increased with DES (OR, 1.71; 95% CI, 1.05-2.79; p=0.03).

Conclusions: At long-term follow-up, percutaneous coronary intervention with DES reduces need for target-vessel revascularization, without increasing the risk for death and reinfarction. However, the strong reduction in reintervention with DES trades off a slight but significant increase in very late stent thrombosis.