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Title: | Effects of cobalt-chromium everolimus eluting stents or bare metal stent on fatal and non-fatal cardiovascular events: patient level meta-analysis |
Author: | Valgimigli, Marco Sabaté Tenas, Manuel Kaiser, Cristoph Brugaletta, Salvatore Torre Hernández, José María de la Galatius, Soeren Cequier Fillat, Àngel R. Eberli, Franz De Belder, Adam Serruys, Patrick W. Ferrante, Giuseppe |
Keywords: | Malalties coronàries Artèries coronàries Infart de miocardi Pròtesis de Stent Coronary diseases Coronary arteries Myocardial infarction Stents (Surgery) |
Issue Date: | 4-Nov-2014 |
Publisher: | BMJ Publishing Group |
Abstract: | Objectives: To examine the safety and effectiveness of cobalt-chromium everolimus eluting stents compared with bare metal stents. Design: Individual patient data meta-analysis of randomised controlled trials. Cox proportional regression models stratified by trial, containing random effects, were used to assess the impact of stent type on outcomes. Hazard ratios with 95% confidence interval for outcomes were reported. Data sources and study selection: Medline, Embase, the Cochrane Central Register of Controlled Trials. Randomised controlled trials that compared cobalt-chromium everolimus eluting stents with bare metal stents were selected. The principal investigators whose trials met the inclusion criteria provided data for individual patients. Primary outcomes: The primary outcome was cardiac mortality. Secondary endpoints were myocardial infarction, definite stent thrombosis, definite or probable stent thrombosis, target vessel revascularisation, and all cause death. Results: The search yielded five randomised controlled trials, comprising 4896 participants. Compared with patients receiving bare metal stents, participants receiving cobalt-chromium everolimus eluting stents had a significant reduction of cardiac mortality (hazard ratio 0.67, 95% confidence interval 0.49 to 0.91; P=0.01), myocardial infarction (0.71, 0.55 to 0.92; P=0.01), definite stent thrombosis (0.41, 0.22 to 0.76; P=0.005), definite or probable stent thrombosis (0.48, 0.31 to 0.73; P<0.001), and target vessel revascularisation (0.29, 0.20 to 0.41; P<0.001) at a median follow-up of 720 days. There was no significant difference in all cause death between groups (0.83, 0.65 to 1.06; P=0.14). Findings remained unchanged at multivariable regression after adjustment for the acuity of clinical syndrome (for instance, acute coronary syndrome v stable coronary artery disease), diabetes mellitus, female sex, use of glycoprotein IIb/IIIa inhibitors, and up to one year v longer duration treatment with dual antiplatelets. Conclusions: This meta-analysis offers evidence that compared with bare metal stents the use of cobalt-chromium everolimus eluting stents improves global cardiovascular outcomes including cardiac survival, myocardial infarction, and overall stent thrombosis. |
Note: | Reproducció del document publicat a: http://dx.doi.org/10.1136/bmj.g6427 |
It is part of: | BMJ Open, 2014, vol. 349, p. 1-17 |
URI: | http://hdl.handle.net/2445/65899 |
Related resource: | http://dx.doi.org/10.1136/bmj.g6427 |
ISSN: | 2044-6055 |
Appears in Collections: | Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) Articles publicats en revistes (Medicina) Articles publicats en revistes (Ciències Clíniques) |
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