Long-term clinical outcomes following sirolimus-eluting stent implantation in patients with acute myocardial infarction. A meta-analysis of randomized trials

Clinical Research in Cardiology, 05/29/2012

At long–term follow–up, SES compared to BMS use in STEMI patients reduces the risk of target–vessel revascularization, without increasing the risk of death and reinfarction. However, the strong SES efficacy is counterbalanced by a significant risk of very late stent thrombosis.

Methods

  • A systematic literature search of electronic resources, through October 2011, was performed using specific search terms.
  • Included trials were randomized studies comparing SES to BMS in STEMI patients, with a follow–up ≥3 years.

Results

  • 7 trials were included, with a total of 2,364 patients.
  • At a median follow–up of 3 years, SES significantly reduced the risk of target–vessel revascularization when compared with BMS [odds ratio (OR), 0.44; 95 % confidence interval (CI), 0.34–0.57; p < 0.0001], without increasing the risk of mortality (OR 0.78; 95 % CI, 0.57–1.08; p = 0.14), reinfarction (OR 0.91; 95 % CI, 0.61–1.35, p = 0.64) and early to late stent thrombosis (OR 0.77; 95 % CI, 0.49–1.20; p = 0.25).
  • However after the first year, SES did not further reduce target–vessel revascularization (OR 1.06; 95 % CI, 0.64–1.74; p = 0.83) and increased the risk of very late stent thrombosis (OR 2.81; 95 % CI, 1.33–5.92; p = 0.007).

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