Clinical outcomes of primary stenting versus balloon angioplasty in patients with myocardial infarction: a meta-analysis of randomized controlled trials

doi:10.1016/j.amjmed.2003.08.035

The American Journal of Medicine

Volume 116, Issue 4, 15 February 2004, Pages 253-262

https://doi.org/10.1016/j.amjmed.2003.08.035 Get rights and content

Abstract

Purpose

To examine whether primary stenting as compared with primary balloon angioplasty reduces clinical outcomes in patients with myocardial infarction.

Methods

Major medical databases from 1979 to March 2002 were searched for randomized controlled trials that compared primary stenting with balloon angioplasty in patients with myocardial infarction. Two independent reviewers selected and extracted data from identified trials. The outcomes were mortality at 30 days, 6 months, and 12 months; recurrent events; and bleeding.

Results

Nine trials with a total of 4433 patients fulfilled the inclusion criteria. The odds ratios for mortality after stenting as compared with balloon angioplasty were 1.17 (95% confidence interval [CI]: 0.78 to 1.74) at 30 days, 1.07 (95% CI: 0.76 to 1.52) at 6 months, and 1.09 (95% CI: 0.80 to 1.50) at 12 months (P for heterogeneity >0.1 for each comparison). The odds ratios for reinfarction after stenting as compared with balloon angioplasty were 0.52 (95% CI: 0.31 to 0.87) at 30 days, 0.67 (95% CI: 0.45 to 1.00) at 6 months, and 0.67 (95% CI: 0.45 to 0.99) at 12 months; for target vessel revascularization, they were 0.46 (95% CI: 0.34 to 0.61) at 30 days, 0.42 (95% CI: 0.35 to 0.51) at 6 months, and 0.48 (95% CI: 0.39 to 0.59) at 12 months (P for heterogeneity >0.1 for all estimates with the exception of reinfarction at 12 months where P = 0.08). The odds ratio for postinterventional bleeding complications after stenting as compared with balloon angioplasty was 1.34 (95% CI: 0.95 to 1.88; P for heterogeneity >0.1).

Conclusion

Compared with balloon angioplasty, primary stenting is not associated with lower mortality, but is associated with a lower risk of reinfarction and target vessel revascularization.

Section snippets

Data search and trial selection

We searched MEDLINE, EMBASE, Pascal, Index Medicus, the Cochrane Library, and abstracts from cardiology conferences from 1979 to March 2002 to identify all randomized controlled trials that compared primary stenting with balloon angioplasty in patients with myocardial infarction. We used the following search terms: angioplasty transluminal percutaneous coronary, stents, randomized controlled trials, clinical trials, coronary artery dilatation, transluminal coronary angioplasty, and random. We

Results

Of the 603 potentially relevant publications, 10 met the inclusion criteria 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 (Figure 1). We did not include one trial in which patients were randomly assigned to provisional stenting or to no further intervention after balloon angioplasty had already been performed (21). Another publication that was excluded was a long-term follow-up of a previously published trial (13). Thus, nine trials with a total of 4433 patients were included in the meta-analysis (

Discussion

Our meta-analysis found no evidence that primary stenting in patients with myocardial infarction reduced overall mortality compared with balloon angioplasty. However, primary stenting reduced the risk of reinfarction and target vessel revascularization, as compared with balloon angioplasty. At 1 year, an average of 12 (95% CI: 1 to 23) reinfarctions and 144 (95% CI: 66 to 223) target vessel revascularizations were avoided per 1000 patients with myocardial infarction who were treated with

Acknowledgements

We thank C. L. Grines, R. Jaksch, B. Scheller, and G. W. Stone for providing us with additional data from their trials.

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^☆: Supported by Santésuisse and the Gottfried und Julia Bangerter-Rhyner-Foundation. The funding source was not involved in study design, collection, analysis, or interpretation of data, and had no influence on the writing of, on the decision to submit, the paper.

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ReviewClinical outcomes of primary stenting versus balloon angioplasty in patients with myocardial infarction: a meta-analysis of randomized controlled trials☆

Abstract

Purpose

Methods

Results

Conclusion

Section snippets

Data search and trial selection

Results

Discussion

Acknowledgements

Lancet

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Control Clin Trials

J Clin Epidemiol

Am J Cardiol

J Am Coll Cardiol

Am J Med

J Am Coll Cardiol

Lancet

Am Heart J

Bias in meta-analysis detected by a simple, graphical test

BMJ

Review
Clinical outcomes of primary stenting versus balloon angioplasty in patients with myocardial infarction: a meta-analysis of randomized controlled trials☆