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Clinical Research in Cardiology
Published in: Clinical Research in Cardiology 9/2014

01-09-2014 | Original Paper

Drug-eluting stents in patients with anterior STEMI undergoing primary angioplasty: a substudy of the DESERT cooperation

Authors: Giuseppe De Luca, Maurits T. Dirksen, Christian Spaulding, Henning Kelbæk, Martin Schalij, Leif Thuesen, Bas van der Hoeven, Marteen A. Vink, Christoph Kaiser, Carmine Musto, Tania Chechi, Gaia Spaziani, Luis Salvador Diaz de la Llera, Vincenzo Pasceri, Emilio Di Lorenzo, Roberto Violini, Harry Suryapranata, Gregg W. Stone

Published in: Clinical Research in Cardiology | Issue 9/2014

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Abstract

Background

Several concerns have emerged on the higher risk of in-stent thrombosis after drug-eluting stent (DES) implantation, especially in the setting of STEMI patients. Few data have even been reported in high-risk patients, such as those with anterior MI. Therefore this represents the aim of the current study.

Methods

The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL). We examined all completed randomized trials of DES for STEMI. The following key words were used for study selection: randomized trial, myocardial infarction, reperfusion, primary angioplasty, stenting, DES, sirolimus-eluting stent (SES), Cypher, paclitaxel-eluting stent (PES), Taxus. No language restrictions were enforced.

Results

Individual patient’s data were obtained from 11 out of 13 trials, including a total of 2,782 patients with anterior MI [1,739 or 62.5 % randomized to DES and 1,043 or 37.5 % randomized to bare-metal stent (BMS)]. At long-term follow-up, no significant benefit was observed with DES as compared to BMS in terms of mortality [9.8 vs 10.9 %, HR (95 % CI) = 0.81 (0.61, 1.07), p = 0.13, p heterogeneity = 0.18], reinfarction [8.8 vs 6.4 %, respectively; HR (95 % CI) = 1.14 (0.80, 1.61), p = 0.47, p heterogeneity = 0.82], and stent thrombosis [5.6 vs 5 %, OR (95 % CI) = 0.88 (0.59, 1.30), p = 0.51, p heterogeneity = 0.65], whereas DES was associated with a significant reduction in terms of target-vessel revascularization (TVR) [13.7 vs 23.4 %; OR (95 % CI) = 0.56 (0.46, 0.69), p < 0.0001, p het = 0.81] that was observed at both early (within 1 year) [7 vs 14.7 %, HR (95 % CI) = 0.56 (0.46, 0.69), p < 0.0001, p het = 0.81] and late (>1 year) follow-up [7.2 vs 9 %, HR (95 % CI) = 0.67 (0.47, 0.96), p = 0.03, p het = 0.96].

Conclusions

This study showed that among patients with anterior STEMI undergoing primary angioplasty, SES and PES, as compared to BMS, are associated with a significant reduction in TVR at long-term follow-up. No concerns were found with the use of first-generation DES in terms of mortality.
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Metadata
Title
Drug-eluting stents in patients with anterior STEMI undergoing primary angioplasty: a substudy of the DESERT cooperation
Authors
Giuseppe De Luca
Maurits T. Dirksen
Christian Spaulding
Henning Kelbæk
Martin Schalij
Leif Thuesen
Bas van der Hoeven
Marteen A. Vink
Christoph Kaiser
Carmine Musto
Tania Chechi
Gaia Spaziani
Luis Salvador Diaz de la Llera
Vincenzo Pasceri
Emilio Di Lorenzo
Roberto Violini
Harry Suryapranata
Gregg W. Stone
Publication date
01-09-2014
Publisher
Springer Berlin Heidelberg
Published in
Clinical Research in Cardiology / Issue 9/2014
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-014-0702-6

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