Skip to main content Accessibility help

Drug-eluting stents versus bare-metal stents in acute myocardial infarction: A systematic review and meta-analysis

  • Hae Sun Suh (a1), Hyun Jin Song (a1), Ji Eun Choi (a1), Eun Jin Jang (a1), Hee Jeong Son (a1), Sang Moo Lee (a1), Jung-Sun Kim (a2) and Donghoon Choi (a3)...


Objectives: Recent concerns have been raised for the safety after drug-eluting stents (DES) implantation compared with the use of bare-metal stents (BMS) in patients with ST-elevation acute myocardial infarction (STEMI). The objective of this study was to estimate the relative impact of DES versus BMS on mortality, myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis (ST) in STEMI patients by performing comprehensive meta-analyses of randomized controlled trials (RCTs) and observational studies.

Methods: We performed an electronic search and manual search of studies presented through September 2009, without language restrictions. An approach of “using systematic reviews” was used. Two independent reviewers extracted prespecified data from each study. A random-effects model was used to combine trials and to perform stratified analyses based on study designs and the duration of follow-up.

Results: Fourteen RCTs were identified (N = 7,654). Compared with BMS, DES significantly reduced TVR (risk ratio [RR], 0.48; 95 percent confidence interval [CI], 0.41–0.56) and MI (RR, 0.77; 95 percent CI, 0.61–0.97), without increasing mortality (RR, 0.88; 95 percent CI, 0.70–1.10) and ST (RR, 0.93; 95 percent CI, 0.72–1.21). Among 35 observational studies (N = 44,849), the use of DES was associated with a significant reduction in mortality (RR, 0.85; 95 percent CI, 0.79–0.91) and TVR (RR, 0.61; 95 percent CI, 0.48–0.77). MI and ST were significantly lower in the DES group within 1-year follow-up, but there were no differences within 2 years of follow-up. There was no evidence of statistical heterogeneity and publication bias.

Conclusions: These data in aggregate suggest that using DES in STEMI patients is safe and efficacious, but there are differences between RCT and observational data comparing DES and BMS.



Hide All
1. Brar, SS, Leon, MB, Stone, GW, et al. Use of drug-eluting stents in acute myocardial infarction: A systematic review and meta-analysis. J Am Coll Cardiol. 2009;53:16771689.
2. Begg, CB, Mazumdar, M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:10881101.
3. De Luca, G, Stone, GW, Suryapranata, H, et al. Efficacy and safety of drug-eluting stents in ST-segment elevation myocardial infarction: A meta-analysis of randomized trials. Int J Cardiol. 2009;133:213222.
4. De Luca, G, Valgimigli, M, Spaulding, C, et al. Short and long-term benefits of sirolimus-eluting stent in ST-segment elevation myocardial infarction: A meta-analysis of randomized trials. J Thromb Thrombolysis. 2009;28:200210.
5. DerSimonian, R, Laird, N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177188.
6. Duval, S, Tweedie, R. Trim and fill: A simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56:455463.
7. Egger, M, Smith, GD, Schneider, M, Minder, C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629634.
8. Finn, AV, Nakazawa, G, Kolodgie, F, Virmani, R. Drug eluting or bare metal stent for acute myocardial infarction: An issue of safety? Eur Heart J. 2009;30:18281830.
9. Guyatt, GH, Oxman, AD, Vist, GE, et al. GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924926.
10. Higgins, JPT, Green, S. Cochrane handbook for systematic reviews of interventions version 5.0.2 (updated September 2009). The Cochrane Collaboration, 2009. (accessed October 1, 2009).
11. Higgins, JPT, Thompson, SG, Deeks, JJ, Altman, DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557560.
12. Hill, RA, Boland, A, Dickson, R, et al. Drug-eluting stents: A systematic review and economic evaluation. Health Technol Assess. 2007;11:iii, xi-221.
13. Iijima, R, Byrne, RA, Dibra, A, et al. Drug-eluting stents versus bare-metal stents in diabetic patients with ST-segment elevation acute myocardial infarction: A pooled analysis of individual patient data from seven randomized trials. Rev Esp Cardiol. 2009;62:354364.
14. Kastrati, A, Dibra, A, Spaulding, C, et al. Meta-analysis of randomized trials on drug-eluting stents vs. bare-metal stents in patients with acute myocardial infarction. Eur Heart J. 2007;28:27062713.
15. Kim, SS, Park, DW, Seo, JS, et al. Abstract AS-190: Long-term clinical outcomes with drug-eluting versus bare metal stents in ST-segment elevation myocardial infarction. Am J Cardiol. 2009;103 (Suppl 1):81B.
16. Kushner, FG, Hand, M, Smith, SC Jr, et al. 2009. Focused updates: ACC/AHA Guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI Guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2009;120:22712306.
17. Kuukasjarvi, P, Malmivaara, A, Halinen, M, et al. Overview of systematic reviews on invasive treatment of stable coronary artery disease. Int J Technol Assess Health Care. 2006;22:219234.
18. Moreno, R, Fernandez, C, Calvo, L, et al. Meta-analysis comparing the effect of drug-eluting versus bare metal stents on risk of acute myocardial infarction during follow-up. Am J Cardiol. 2007;99:621625.
19. Nakamura, S, Bae, J, Cahyadi, YH, et al. Three-year follow-up of patients with ST-segment evelation acute myocardial infarction treated with sirolimus-eluting stent and paclitaxel-eluting stent: Multicenter registry in Asia. Circulation. 2006;114 (II_516):Abstract 2503.
20. NECA. Drug-eluting stents versus bare-metal stents in acute myocardial infarction (NA2009-015). Seoul, Korea: The National Evidence-based Healthcare Collaborating Agency (NECA); 2010.
21. Nordmann, AJ, Hengstler, P, Leimenstoll, BM, et al. Clinical outcomes of stents versus balloon angioplasty in non-acute coronary artery disease. Eur Heart J. 2004;25:6980.
22. Pan, XH, Zhong, WZ, Xiang, MX, et al. Clinical outcomes of serolimus-eluting stents versus bare metal stents in ST-segment elevation myocardial infarction patients: A meta-analysis. Chin Med J (Engl). 2009;122:8892.
23. Park, KW, Kang, SH, Lee, HY, et al. Abstract TCT-315: ‘Real World’ comparison of drug-eluting stents versus bare metal stents in the treatment of unselected patients with acute ST-segment elevation myocardial infarction: Mid to long term results from a two center registry. Am J Cardiol. 2008;102 (Suppl 1):128i.
24. Pasceri, V, Patti, G, Speciale, G, et al. Meta-analysis of clinical trials on use of drug-eluting stents for treatment of acute myocardial infarction. Am Heart J. 2007;153:749754.
25. Piscione, F, Piccolo, R, Cassese, S, Galasso, G, Chiariello, M. Clinical impact of sirolimus-eluting stent in ST-segment elevation myocardial infarction: A meta-analysis of randomized clinical trials. Catheter Cardiovasc Interv. 2009;74:323332.
26. Shea, BJ, Hamel, C, Wells, GA, et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol. 2009;62:10131020.
27. Slim, K, Nini, E, Forestier, D, et al. Methodological index for non-randomized studies (MINORS): Development and validation of a new instrument. ANZ J Surg. 2003;73:712716.
28. Valgimigli, M, Campo, G, Arcozzi, C, et al. Two-year clinical follow-up after sirolimus-eluting versus bare-metal stent implantation assisted by systematic glycoprotein IIb/IIIa inhibitor infusion in patients with myocardial infarction: Results from the STRATEGY study. J Am Coll Cardiol. 2007;50:138145.


Type Description Title
Supplementary materials

Suh supplementary material
Figures and Tables

 Unknown (349 KB)
349 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed