Department of Clinical Medicine, Cardiovascular Sciences and Immunology, Federico II University, Naples, Italy.
EuroIntervention. 2010 Feb;5(7):853-60. doi: 10.4244/eijv5i7a143.
The role of drug-eluting stent (DES) remains an unsettled issue in patients with ST-segment elevation myocardial infarction (STEMI). Therefore, we performed a meta-analysis of randomised trials to evaluate the clinical outcome of DES as compared with bare-metal stent (BMS) after percutaneous coronary intervention (PCI).
We undertook a literature search until July 2009. Thirteen clinical trials met inclusion criteria, with 7,244 patients enrolled. Up to 1-year, patients treated with DES as compared with BMS experienced less target-vessel revascularisation (TVR) (5.11% versus 11.19% respectively, p<0.00001) and recurrent myocardial infarction rates (3.03% versus 3.70% respectively, p=0.02). In addition, no significant differences were found in terms of cardiac death (2.80% versus 3.52%, p=0.21) and stent thrombosis (2.65% versus 2.76%, p=0.37). Using the adjusted indirect comparison, a significant difference between sirolimus- and paclitaxel-eluting stent was found when TVR was evaluated (OR [95% CI] =0.59 [0.40-0.89], p=0.01), without differences in other clinical outcomes.
In patients undergoing PCI for STEMI, treatment with DES is associated with decreased TVR and myocardial infarction rates, without increasing cardiac death or stent thrombosis occurrence. Sirolimus-eluting stent is associated with a greater TVR reduction as compared to paclitaxel-eluting stent.
药物洗脱支架（DES）在 ST 段抬高型心肌梗死（STEMI）患者中的作用仍存在争议。因此，我们进行了一项荟萃分析，以评估经皮冠状动脉介入治疗（PCI）后与裸金属支架（BMS）相比，DES 的临床结果。
我们进行了文献检索，截至 2009 年 7 月。共有 13 项临床试验符合纳入标准，共纳入 7244 例患者。在 1 年时，DES 组患者的靶血管血运重建（TVR）（分别为 5.11%和 11.19%，p<0.00001）和再发心肌梗死率（分别为 3.03%和 3.70%，p=0.02）均较低。此外，在心脏死亡（分别为 2.80%和 3.52%，p=0.21）和支架血栓形成（分别为 2.65%和 2.76%，p=0.37）方面也无显著差异。采用调整后的间接比较，在评估 TVR 时，发现西罗莫司洗脱支架与紫杉醇洗脱支架之间存在显著差异（OR[95%CI]=0.59[0.40-0.89]，p=0.01），但其他临床结局无差异。
在 STEMI 患者接受 PCI 治疗时，DES 的应用与 TVR 和心肌梗死发生率降低相关，而不会增加心脏死亡或支架血栓形成的发生率。与紫杉醇洗脱支架相比，西罗莫司洗脱支架与更大的 TVR 降低相关。
