• Giuseppe De Luca, Maurits T Dirksen, Christian Spaulding, Henning Kelbaek, Martin Schalij, Leif Thuesen, Bas van der Hoeven, Marteen A Vink, Christoph Kaiser, Carmine Musto, Tania Chechi, Gaia Spaziani, Luis Salvador Díaz de la Llera, Vincenzo Pasceri, Emilio Di Lorenzo, Roberto Violini, Giuliana Cortese, Harry Suryapranata, Gregg W Stone, and Drug-Eluting Stent in Primary Angioplasty (DESERT) Cooperation.
• Division of Cardiology, Ospedale "Maggiore della Carità," Eastern Piedmont University, Novara, Italy. giuseppe.deluca@maggioreosp.novara.it
• Arch Intern Med. 2012 Apr 23; 172 (8): 611-21; discussion 621-2.

BackgroundConcerns have emerged regarding a higher risk of stent thrombosis after drug-eluting stent (DES) implantation, especially in the setting of ST-segment elevation myocardial infarction (STEMI). Our objective was to perform a meta-analysis using individual patient data to evaluate the long-term safety and effectiveness of DES compared with bare-metal stents (BMS) in patients undergoing primary percutaneous coronary intervention for STEMI.Data SourcesFormal searches of electronic databases (MEDLINE and CENTRAL) and scientific session presentations from January 2000 to June 2011.Study SelectionWe examined all completed randomized trials of DES for STEMI.Data ExtractionIndividual patient data.Data SynthesisIndividual patient data were obtained from 11 of 13 trials identified, including a total of 6298 patients (3980 [63.2%] randomized to DES [99% sirolimus-eluting or paclitaxel-eluting stents] and 2318 [36.8%] randomized to BMS). At long-term follow-up (mean [SD], 1201 [440] days), DES implantation significantly reduced the occurrence of target-vessel revascularization (12.7% vs 20.1%; hazard ratio [95% CI], 0.57 [0.50-0.66]; P < .001, P value for heterogeneity, .20), without any significant difference in terms of mortality, reinfarction, and stent thrombosis. However, DES implantation was associated with an increased risk of very late stent thrombosis and reinfarction.ConclusionsThe present pooled patient-level meta-analysis demonstrates that among patients with STEMI undergoing primary percutaneous coronary intervention, sirolimus-eluting and paclitaxel-eluting stents compared with BMS are associated with a significant reduction in target-vessel revascularization at long-term follow-up. Although there were no differences in cumulative mortality, reinfarction, or stent thrombosis, the incidence of very late reinfarction and stent thrombosis was increased with these DES.

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