Dipartimento Cardiovascolare, Policlinico Sant' Orsola, Bologna, Italy.
J Am Coll Cardiol. 2013 Aug 6;62(6):496-504. doi: 10.1016/j.jacc.2013.05.022. Epub 2013 Jun 7.
The 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.
The 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.
Randomized 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.
Twenty-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.
In 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.
作者通过网络荟萃分析研究了不同药物洗脱支架（DES）和裸金属支架（BMS）在 ST 段抬高型心肌梗死（STEMI）患者中的相对安全性和疗效。
DES 和 BMS 在 STEMI 患者中的相对安全性仍存在争议，并且是否在这方面随着第二代 DES 的出现而有所改进尚不清楚。
使用 MEDLINE、EMBASE 和 Cochrane 数据库搜索比较目前美国批准的 DES 或 DES 与 BMS 在 STEMI 患者中的随机对照试验。提取有关研究设计、纳入和排除标准、样本特征和临床结局的信息。
共分析了 22 项试验，包括 12453 名随机患者。在 1 年随访时，与 BMS 相比，钴铬依维莫司洗脱支架（CoCr-EES）的心脏死亡或心肌梗死（MI）和支架血栓形成（ST）发生率明显降低。30 天即可观察到 ST 差异，并且持续 2 年。CoCr-EES 也与 1 年 ST 发生率明显低于紫杉醇洗脱支架（PES）相关。西罗莫司洗脱支架（SES）也与 BMS 相比，1 年心脏死亡/心肌梗死发生率明显降低。与 BMS 相比，CoCr-EES、PES 和 SES，但不是佐他莫司洗脱支架，1 年靶血管血运重建（TVR）发生率明显降低，SES 与 PES 相比，TVR 发生率也较低。
在 STEMI 患者中，从 BMS 发展到第一代和现在的第二代 DES，结果不断得到改善，CoCr-EES 迄今为止表现出最有利的安全性和疗效。
