Sabaté, ManelManelSabatéRäber, LorenzLorenzRäberHeg, Dierik HansDierik HansHeg0000-0002-8766-7945Brugaletta, SalvatoreSalvatoreBrugalettaKelbaek, HenningHenningKelbaekCequier, AngelAngelCequierOstojic, MiodragMiodragOstojicIñiguez, AndrésAndrésIñiguezTüller, DavidDavidTüllerSerra, AntonioAntonioSerraBaumbach, AndreasAndreasBaumbachvon Birgelen, ClemensClemensvon BirgelenHernandez-Antolin, RosanaRosanaHernandez-AntolinRoffi, MarcoMarcoRoffiMainar, VicenteVicenteMainarValgimigli, MarcoMarcoValgimigliSerruys, Patrick WPatrick WSerruysJüni, PeterPeterJüniWindecker, StephanStephanWindecker2024-10-142024-10-142014-01https://boris-portal.unibe.ch/handle/20.500.12422/113110OBJECTIVES This study sought to study the efficacy and safety of newer-generation drug-eluting stents (DES) compared with bare-metal stents (BMS) in an appropriately powered population of patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND Among patients with STEMI, early generation DES improved efficacy but not safety compared with BMS. Newer-generation DES, everolimus-eluting stents, and biolimus A9-eluting stents, have been shown to improve clinical outcomes compared with early generation DES. METHODS Individual patient data for 2,665 STEMI patients enrolled in 2 large-scale randomized clinical trials comparing newer-generation DES with BMS were pooled: 1,326 patients received a newer-generation DES (everolimus-eluting stent or biolimus A9-eluting stent), whereas the remaining 1,329 patients received a BMS. Random-effects models were used to assess differences between the 2 groups for the device-oriented composite endpoint of cardiac death, target-vessel reinfarction, and target-lesion revascularization and the patient-oriented composite endpoint of all-cause death, any infarction, and any revascularization at 1 year. RESULTS Newer-generation DES substantially reduce the risk of the device-oriented composite endpoint compared with BMS at 1 year (relative risk [RR]: 0.58; 95% confidence interval [CI]: 0.43 to 0.79; p = 0.0004). Similarly, the risk of the patient-oriented composite endpoint was lower with newer-generation DES than BMS (RR: 0.78; 95% CI: 0.63 to 0.96; p = 0.02). Differences in favor of newer-generation DES were driven by both a lower risk of repeat revascularization of the target lesion (RR: 0.33; 95% CI: 0.20 to 0.52; p < 0.0001) and a lower risk of target-vessel infarction (RR: 0.36; 95% CI: 0.14 to 0.92; p = 0.03). Newer-generation DES also reduced the risk of definite stent thrombosis (RR: 0.35; 95% CI: 0.16 to 0.75; p = 0.006) compared with BMS. CONCLUSIONS Among patients with STEMI, newer-generation DES improve safety and efficacy compared with BMS throughout 1 year. It remains to be determined whether the differences in favor of newer-generation DES are sustained during long-term follow-up.enBES BMS CI DES DOCE EES HR POCE RR ST-segment elevation myocardial infarction STEMI bare-metal stent(s) biolimus A9–eluting stent(s) confidence interval device-oriented composite endpoint drug-eluting stent(s) everolimus-eluting stent(s) hazard ratio patient-oriented composite endpoint relative risk stent thrombosis600 - Technology::610 - Medicine & health300 - Social sciences, sociology & anthropology::360 - Social problems & social servicesarticle10.7892/boris.411112433241910.1016/j.jcin.2013.07.012