Publications (4)23.68 Total impact
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Article: Short and long-term benefits of sirolimus-eluting stent in ST-segment elevation myocardial infarction: a meta-analysis of randomized trials
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ABSTRACT: Background Recent concerns have emerged on the potential higher risk of stent thrombosis after DES implantation, that might be even more pronounced among STEMI patients. The aim of the current study was to perform a meta-analysis to evaluate the benefits and safety of Sirolimus-Eluting Stent (SES) as compared to BMS in patients undergoing primary angioplasty for STEMI. Methods The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL). We examined all completed randomized trials of DES for STEMI. The following keywords were used for study selection: randomized trial, myocardial infarction, reperfusion, primary angioplasty, stenting, DES, sirolimus-eluting stent (SES), Cypher. Information on study design, type of stent, inclusion and exclusion criteria, primary endpoint, number of patients, angiographic and clinical outcome, were extracted by two investigators. Disagreements were resolved by consensus. Results A total of 9 trials were included in the meta-analysis, involving 2,769 patients (1389 or 50.2% randomized to DES and 1,380 or 49.8% randomized to BMS). At 12months follow-up, SES was associated with a significant reduction in TVR (4.9% vs. 13.6%, p<0.0001), with a trend in benefits in mortality (2.9% vs. 4.2%, p=0.08) and reinfarction (3.0% vs. 4.3%, p=0.06), without any significant difference in stent thrombosis (1.9% vs. 2.5%, p=0.36). Safety and efficacy of DES were confirmed at 2–3years follow-up (data available from 4 trials including 569 patients). Conclusions This meta-analysis shows that among selected STEMI patients undergoing primary angioplasty, SES as compared to BMS is safe and associated with a significant reduction in TVR at 1 and 2–3years follow-up.Journal of Thrombosis and Thrombolysis 04/2012; 28(2):200-210. · 1.48 Impact Factor -
Article: Stent thrombosis up to 3 years after stenting for ST-segment elevation myocardial infarction versus for stable angina--comparison of the effects of drug-eluting versus bare-metal stents.
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ABSTRACT: The long-term safety of drug-eluting stents (DES) for the treatment of ST-segment elevation myocardial infarction (STEMI) is unclear and may differ from that in stable angina (stable) patients as noted in autopsy studies. To assess this problem, 210 consecutive STEMI and 323 stable patients, randomized 2:1 to DES versus bare-metal stents (BMS), were followed up for 3 years for definite/probable stent thrombosis (ST) and cardiac death/myocardial infarction. Events occurring during the initial 6 months were separated from later events. The 3-year rate of ST was 8.1% in STEMI vs 3.4% in stable patients (P = .02), with corresponding rates of 9.4% vs 2.9% (P = .01) for DES and of 5.6% vs 4.3% (P = .71) for BMS patients, respectively. This difference appeared only after 6 months: 4.6% in STEMI vs 1.7% in stable patients (P = .05) and in DES-treated patients (6.2% vs 2.0%, P = .05). Results of ST were paralleled by findings of clinical events, although here differences were less pronounced, but also seen only late after stenting. Thus, in STEMI patients, late events occurred more frequently after DES vs BMS implantation (11.6% vs 3.0%, P = .04), compared to results in stable patients (DES 6.4%, BMS 1.9%, P = .08). In this pilot study, we observed an increased rate of late ST and a trend to more related clinical events in patients after stenting for STEMI vs for stable angina, particularly if treated with DES. This may explain outcome differences between results of pivotal trials in stable patients vs those of "real-world" patients.American heart journal 09/2009; 158(2):271-6. · 4.65 Impact Factor -
Article: Efficacy and safety of drug-eluting stents in ST-segment elevation myocardial infarction: a meta-analysis of randomized trials.
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ABSTRACT: Recent concerns have emerged on the potential higher risk of stent thrombosis after DES implantation, that might be even more pronounced among STEMI patients. Thus, the aim of the current study was to perform a meta-analysis to evaluate the benefits and safety of DES as compared to BMS in patients undergoing primary angioplasty for STEMI. The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL). We examined all completed randomized trials of DES for STEMI. The following key words were used for study selection: randomized trial, myocardial infarction, reperfusion, primary angioplasty, stenting, DES, sirolimus-eluting stent (SES), Cypher, paclitaxel-eluting stent (PES), Taxus. Information on study design, type of stent, inclusion and exclusion criteria, primary endpoint, number of patients, angiographic and clinical outcome, were extracted by two investigators. Disagreements were resolved by consensus. A total of 11 trials were included in the meta-analysis, involving 3605 patients (1888 or 52.3% randomized to DES and 1719 or 47.7% randomized to BMS). At 12 months follow-up, no significant difference was observed in mortality (4.1% vs 4.4%, OR [95% CI]=0.91 [0.66-1.27], p=0.59, reinfarction (3.1% vs 3.4%, OR [95% CI]=0.85 [0.58, 1.23], p=0.38 or stent thrombosis (1.6% vs 2.2%, OR [95% CI]=0.76 [0.47, 1.23], p=0.22), whereas DES were associated with a significant reduction in TVR (5.0% vs 12.6%, OR [95% CI]=0.36 [0.28, 0.47], p<0.0001). Safety and efficacy of DES were confirmed at 18 to 24 months follow-up (data available from 4 trials including 1178 patients). This meta-analysis shows that among selected STEMI patients undergoing primary angioplasty, SES and PES, as compared to BMS, are safe and associated with a significant reduction in TVR at 1 and 2 years follow-up.International journal of cardiology 05/2008; 133(2):213-22. · 7.08 Impact Factor -
Article: Meta-analysis of randomized trials on drug-eluting stents vs. bare-metal stents in patients with acute myocardial infarction.
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ABSTRACT: To compare the efficacy and safety of drug-eluting stents vs. bare-metal stents in patients with acute ST-segment elevation myocardial infarction. We performed a meta-analysis of eight randomized trials comparing drug-eluting stents (sirolimus-eluting or paclitaxel-eluting stents) with bare-metal stents in 2786 patients with acute ST-segment elevation myocardial infarction. All patients were followed up for a mean of 12.0-24.2 months. Individual data were available for seven trials with 2476 patients. The primary efficacy endpoint was the need for reintervention (target lesion revascularization). The primary safety endpoint was stent thrombosis. Other outcomes of interest were death and recurrent myocardial infarction. Drug-eluting stents significantly reduced the risk of reintervention, hazard ratio of 0.38 (95% CI, 0.29-0.50), P < 0.001. The overall risk of stent thrombosis: hazard ratio of 0.80 (95% CI, 0.46-1.39), P = 0.43; death: hazard ratio of 0.76 (95% CI, 0.53-1.10), P = 0.14; and recurrent myocardial infarction: hazard ratio of 0.72 (95% CI, 0.48-1.08, P = 0.11) was not significantly different for patients receiving drug-eluting stents vs. bare-metal stents. The use of drug-eluting stents in patients with acute ST-segment elevation myocardial infarction is safe and improves clinical outcomes by reducing the risk of reintervention compared with bare-metal stents.European Heart Journal 12/2007; 28(22):2706-13. · 10.48 Impact Factor
