A meta-analysis of randomized trials on clinical outcomes of paclitaxel-eluting stents versus bare-metal stents in ST-segment elevation myocardial infarction patients

摘要

A meta-analysis was performed to address the efficacy and safety of paclitaxel-eluting stent (PES) in ST-segment elevation myocardial infarction (STEMI) patients. A systematic literature search was conducted to identify all randomized clinical trials in mortality, recurrent myocardial infarction (rMI), repeat revascularization (RR), and stent thrombosis (ST). A total of 4190 STEMI patients were enrolled in six randomized trials comparing PES with bare-metal stent (BMS). The pooled repeat revascularization rate was 5.7 in PES group, significantly lower than 10.0 in BMS group with an odds ratio (OR) of 0.56, 95 confidence interval (CI) 0.44, 0.72 (P<0.00001). No significant difference was found between PES and BMS groups in mortality at one year after the indexing procedure (3.9 vs. 5.1, OR 0.88, 95 CI 0.63, 1.21, P=0.42). Similarly, rMI rate did not differ significantly between the two groups (3.4 vs. 4.1, OR 0.80, 95 CI 0.56, 1.13, P=0.21). PES was also associated with the comparable pooled rate of definite stent thrombosis with BMS (2.3 vs. 2.4, OR 0.81, 95 CI 0.52, 1.26, P=0.35). The results show that PES improved clinical outcomes in STEMI patients with a decreased need for repeat revascularization and no concerns for safety.