Original title: Stent thrombosis with second-generation drug-eluting stents compared with bare-metal stents: Network meta-analysis of primary percutaneous coronary intervention trials in ST-segment–elevation myocardial infarction. Reference: Circ Cardiovasc Interv. 2013; Epub ahead of print.

To compare the safety and efficacy of 2nd generation drug-eluting stents (DES) versus bare metal stents (BMS) in the context of primary angioplasty was conducted this meta-analysis that included 21 works with all types of stents (1st  generation DES, 2nd  generation DES and BMS) for this indication. In total, these 21 studies totaled 12866 patients with 2 jobs who provided direct evidence (2nd generation DES versus BMS) and 19 jobs with indirect evidence (15 comparing 1st generation DES versus BMS and 4 comparing 1st generation DES versus 2nd generation). Both at 30 days (OR 0.36, CI 95% 0.15 to 0.82) and one year (OR 0.49, CI 95%, 0.30 to 0.79) stent thrombosis incidence was significantly lower with 2nd generation DES compared with BMS. Similar to thrombosis, re-infarction (OR 0.3, CI 95%, 0.17 to 0.54) and revascularization (OR 0.54, CI 95%, 0.80 to 0.98) were also lower at one year with 2nd generation DES. Mortality in contrast, showed no significant differences both, after 30 days as well as one year between the 2 devices.

Conclusion:

This meta-analysis of randomized trials in primary angioplasty showed a lower incidence of stent thrombosis, myocardial infarction and target vessel revascularization with 2nd generation drug-eluting stents compared with conventional stents. 

Editorial comment

This study has methodological limitations; basically the only direct evidence comes from 2 studies with the remainder of the proxy data. It was also a limitation, considering the fact within the 2nd generation DES those with permanent polymer and bio-absorbable polymer that maybe could have different safety and efficacy (although the evidence available in the NEXT trial suggests otherwise).

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