Sirolimus-Eluting Stents versus Bare-Metal Stents for Patients with ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Randomized Controlled Trials_Chinese Journal of Evidence-Based Medicine

Authors：

TANG Yang ,  TANG Xuewen

Department of Cardiology, People's Hospital of Banan District of Chongqing, Chongqing 401320, China;

Corresponding author：

TANG Xuewen, Email: txw697@sohu.com

Keywords：

Sirolimus-eluting stents; Bare-metal stents; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20120031

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　 To systematically evaluate the efficacy and safety of sirolimus-eluting stents (SES) versus bare-metal stents (BMS) in treating patients with ST-segment elevation myocardial infarction.
Methods 　 The databases such as PubMed (1960 to Mar. 2011), EMbase (1980 to Mar. 2011), the Cochrane Central Register of Controlled Trials (1989 to Mar. 2011), CBM (1979 to Mar. 2011), VIP (1989 to Mar. 2011) and CNKI (1979 to Mar. 2011) were searched to collect all the randomized controlled trials (RCTs) on SES versus BMS in patients with ST-segment elevation myocardial infarction. After the data extraction and methodological quality evaluation, meta-analysis was conducted with RevMan 4.2 software.
Results 　 A total of 7 RCTs were included. Among 2 555 patients involved, 1 282 were in the SES group, while the other 1273 were in the BMS group. The results of meta-analyses showed that SES was superior to BMS in the target-lesion revascularization (OR=0.27, 95%CI 0.16 to 0.45, P lt;0.000 01) and target-vessel revascularization (OR=0.33, 95%CI 0.24 to 0.46, P lt;0.000 01). In contrast, there were no differences between SES and BMS in death, stent thrombosis and recurrence of myocardial infarction.
Conclusion 　 With the one-year clinical outcomes, SES is more effective than BMS in reducing the rate of target-vessel revascularization and target-lesion revascularization.

Citation： TANG Yang,TANG Xuewen. Sirolimus-Eluting Stents versus Bare-Metal Stents for Patients with ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Randomized Controlled Trials. Chinese Journal of Evidence-Based Medicine, 2012, 12(2): 188-193. doi: 10.7507/1672-2531.20120031 Copy

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2.	Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke statistics–2007 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 2007, 115(5): e69-e171.
3.	Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: A quantitative review of 23 randomised trials. Lancet, 2003, 361(9351): 13-20.
4.	Mehta SR, Cannon CP, Fox KA, et al. Routine vs. selective invasive strategies in patients with acute coronary syndromes: A collaborative meta-analysis of randomized trials. JAMA, 2005, 293(23): 2908-2917.
5.	Boersma E. Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital ?brinolysis in acute myocardial infarction patients. Eur Heart J, 2006, 27(7): 779-788.
6.	Zhu MM, Feit A, Chadow H, et al. Primary stent implantation compared with primary balloon angioplasty for acute myocardial infarction: a meta-analysis of randomized clinical trials. Am J Cardiol, 2001, 88(3): 297-301.
7.	De Luca G, Suryapranata H, Stone GW, et al. Coronary stenting versus balloon angioplasty for acute myocardial infarction: A meta-regression analysis of randomized trials. Int J Cardiol, 2008, 126(1): 37-44.
8.	Brophy JM, Belisle P, Joseph L. Evidence for use of coronary stents. A hierarchical Bayesian meta-analysis. Ann Intern Med, 2003, 138(10): 777-786.
9.	Suryapranata H, De Luca G, van‘t Hof AW, et al. Is routine stenting for acute myocardial infarction superior to balloon angioplasty? A randomised comparison in a large cohort of unselected patients. Heart, 2005, 91(5): 641–645.
10.	Stone GW, Grines CL, Cox DA, et al. Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. N Engl J Med, 2002, 346(13): 957-966.
11.	Maillard L, Hamon M, Khalife K, et al. A comparison of systematic stenting and conventional balloon angioplasty during primary percutaneous transluminal coronary angioplasty for acute myocardial infarction. STENTIM-2 Investigators. J Am Coll Cardiol, 2000, 35(7): 1729-1736.
12.	Moses JW, Leon MB, Popma JJ, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med, 2003, 349(14): 1315-1323.
13.	Schofer J, Schluter M, Gershlick AH, et al. Sirolimus-eluting stents for treatment of patients with long atherosclerotic lesions in small coronary arteries: Double-blind, randomised controlled trial (E-SIR-IUS). Lancet, 2003, 362(9390): 1093-1099.
14.	Dibra A, Kastrati A, Alfonso F, et al. Effectiveness of drug-eluting stents in patients with bare-metal in-stent restenosis: meta-analysis of randomized trials. J Am Coll Cardiol, 2007, 49(5): 616-623.
15.	Kastrati A, Mehilli J, Pache J, et al. Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med, 2007, 356(10): 1030-1039.
16.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
17.	Valgimigli M, Percoco G, Malagutti P, et al. Tirofiban and sirolimus-eluting stent vs abciximab and bare-metal stent for acute myocardial infarction: a randomized trial. JAMA, 2005, 293(17): 2109-2117.
18.	Spaulding C, Henry P, Teiger E, et al. Sirolimus-eluting versus uncoated stents in acute myocardial infarction. N Engl J Med, 2006, 355(11): 1093-1104.
19.	Menichelli M, Parma A, Pucci E, et al. Randomized trial of sirolimus-eluting stent versus bare-metal stent in acute myocardial infarction (SESAMI). J Am Coll Cardiol, 2007, 49(19): 1924-1930.
20.	Diaz de la Llera LS, Ballesteros S, Nevado J, et al. Sirolimus-eluting stents compared with standard stents in the treatment of patients with primary angioplasty. Am Heart J, 2007, 154(1): 164 e1-164 e6.
21.	van der Hoeven BL, Liem SS, Jukema JW, et al. Sirolimus-eluting stents versus bare-metal stents in patients with ST-segment elevation myocardial infarction: 9-month angiographic and intravascular ultrasound results and 12-month clinical outcome results from the MISSION! Intervention Study. J Am Coll Cardiol, 2008, 51(6): 618-626.
22.	Valgimigli M, Campo G, Percoco G, et al. Comparison of angioplasty with infusion of tiro?ban or abciximab and with implantation of sirolimus-eluting or uncoated stents for acute myocardial infarction: The MULTI-STRATEGY randomized trial. JAMA, 2008, 299(15): 1788-1799.
23.	Di Lorenzo E, De Luca G, Sauro R, et al. The PASEO (PaclitAxel or Sirolimus-Eluting Stent Versus Bare Metal Stent in Primary Angioplasty) Randomized Trial. JACC Cardiovasc Interv, 2009, 2(6): 515-523.

1. Fox KA, Steg PG, Eagle KA, et al. Decline in rates of death and heart failure in acute coronary syndromes, 1999–2006. JAMA, 2007, 297(17): 1892-1900.
2. Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke statistics–2007 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 2007, 115(5): e69-e171.
3. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: A quantitative review of 23 randomised trials. Lancet, 2003, 361(9351): 13-20.
4. Mehta SR, Cannon CP, Fox KA, et al. Routine vs. selective invasive strategies in patients with acute coronary syndromes: A collaborative meta-analysis of randomized trials. JAMA, 2005, 293(23): 2908-2917.
5. Boersma E. Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital ?brinolysis in acute myocardial infarction patients. Eur Heart J, 2006, 27(7): 779-788.
6. Zhu MM, Feit A, Chadow H, et al. Primary stent implantation compared with primary balloon angioplasty for acute myocardial infarction: a meta-analysis of randomized clinical trials. Am J Cardiol, 2001, 88(3): 297-301.
7. De Luca G, Suryapranata H, Stone GW, et al. Coronary stenting versus balloon angioplasty for acute myocardial infarction: A meta-regression analysis of randomized trials. Int J Cardiol, 2008, 126(1): 37-44.
8. Brophy JM, Belisle P, Joseph L. Evidence for use of coronary stents. A hierarchical Bayesian meta-analysis. Ann Intern Med, 2003, 138(10): 777-786.
9. Suryapranata H, De Luca G, van‘t Hof AW, et al. Is routine stenting for acute myocardial infarction superior to balloon angioplasty? A randomised comparison in a large cohort of unselected patients. Heart, 2005, 91(5): 641–645.
10. Stone GW, Grines CL, Cox DA, et al. Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. N Engl J Med, 2002, 346(13): 957-966.
11. Maillard L, Hamon M, Khalife K, et al. A comparison of systematic stenting and conventional balloon angioplasty during primary percutaneous transluminal coronary angioplasty for acute myocardial infarction. STENTIM-2 Investigators. J Am Coll Cardiol, 2000, 35(7): 1729-1736.
12. Moses JW, Leon MB, Popma JJ, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med, 2003, 349(14): 1315-1323.
13. Schofer J, Schluter M, Gershlick AH, et al. Sirolimus-eluting stents for treatment of patients with long atherosclerotic lesions in small coronary arteries: Double-blind, randomised controlled trial (E-SIR-IUS). Lancet, 2003, 362(9390): 1093-1099.
14. Dibra A, Kastrati A, Alfonso F, et al. Effectiveness of drug-eluting stents in patients with bare-metal in-stent restenosis: meta-analysis of randomized trials. J Am Coll Cardiol, 2007, 49(5): 616-623.
15. Kastrati A, Mehilli J, Pache J, et al. Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med, 2007, 356(10): 1030-1039.
16. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
17. Valgimigli M, Percoco G, Malagutti P, et al. Tirofiban and sirolimus-eluting stent vs abciximab and bare-metal stent for acute myocardial infarction: a randomized trial. JAMA, 2005, 293(17): 2109-2117.
18. Spaulding C, Henry P, Teiger E, et al. Sirolimus-eluting versus uncoated stents in acute myocardial infarction. N Engl J Med, 2006, 355(11): 1093-1104.
19. Menichelli M, Parma A, Pucci E, et al. Randomized trial of sirolimus-eluting stent versus bare-metal stent in acute myocardial infarction (SESAMI). J Am Coll Cardiol, 2007, 49(19): 1924-1930.
20. Diaz de la Llera LS, Ballesteros S, Nevado J, et al. Sirolimus-eluting stents compared with standard stents in the treatment of patients with primary angioplasty. Am Heart J, 2007, 154(1): 164 e1-164 e6.
21. van der Hoeven BL, Liem SS, Jukema JW, et al. Sirolimus-eluting stents versus bare-metal stents in patients with ST-segment elevation myocardial infarction: 9-month angiographic and intravascular ultrasound results and 12-month clinical outcome results from the MISSION! Intervention Study. J Am Coll Cardiol, 2008, 51(6): 618-626.
22. Valgimigli M, Campo G, Percoco G, et al. Comparison of angioplasty with infusion of tiro?ban or abciximab and with implantation of sirolimus-eluting or uncoated stents for acute myocardial infarction: The MULTI-STRATEGY randomized trial. JAMA, 2008, 299(15): 1788-1799.
23. Di Lorenzo E, De Luca G, Sauro R, et al. The PASEO (PaclitAxel or Sirolimus-Eluting Stent Versus Bare Metal Stent in Primary Angioplasty) Randomized Trial. JACC Cardiovasc Interv, 2009, 2(6): 515-523.

Chinese Journal of Evidence-Based Medicine

Sirolimus-Eluting Stents versus Bare-Metal Stents for Patients with ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Randomized Controlled Trials

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