Clinical impact of sirolimus-eluting stent in ST-segment elevation myocardial infarction: a meta-analysis of randomized clinical trials Piscione F, Piccolo R, Cassese S, Galasso G, Chiariello M CRD summary This review compared outcomes of patients who underwent sirolimus-eluting stent versus bare-metal stent implantation during primary angiography for ST-segment elevation myocardial infarction. The authors concluded that sirolimus- eluting stent significantly reduced target vessel revascularisation rates without increasing stent thrombosis, recurrent myocardial infarction and death rates up to 12-month follow-up. These conclusions follow from the evidence and are likely to be reliable. Authors' objectives To compare outcomes of patients who underwent sirolimus-eluting stent (SES) versus bare-metal stent (BMS) implantation during primary angiography for ST-segment elevation myocardial infarction (STEMI). Searching MEDLINE, EMBASE and Cochrane Central Register of Contolled Trials (CENTRAL) were searched from inception to October 2008 for relevant studies published in any language. Search terms were reported. Reference lists of retrieved articles were screened, as were conference abstracts published in core cardiology journals and on cardiology websites. Study selection Randomised controlled trials (RCTs) with over 100 patients and a mean follow-up period of at least six months were eligible for inclusion in the review. RCTs were required to have at least 90% complete follow-up and perform intention- to-treat analyses. The authors appeared to restrict inclusion to studies that directly compared sirolimus-eluting stent to bare-metal stent. Outcomes evaluated in included studies were target vessel failure, angiographic restenosis, lumen loss and combined death and non-fatal myocardial infarction with recurrent myocardial ischaemia or with stroke and binary restenosis. Length of follow-up ranged from eight to 12 months. Two reviewers independently selected studies for inclusion. Disagreements were resolved by a third reviewer. Assessment of study quality Validity of the included trials was assessed using Jadad criteria, which allocate studies up to 5 points based on randomisation, blinding and patient follow-up. Studies that scored 3 or more points were considered high quality. Two reviewers independently assessed study quality. Data extraction The primary efficacy outcome was target vessel revascularisation. The primary safety outcome was stent thrombosis. Relevant data were extracted to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for these outcomes. The authors did not state how many reviewers performed the extraction. Methods of synthesis Pooled odds ratios were calculated using the Mantel-Haenszel fixed-effect model. Statistical heterogeneity was investigated using Χ 2 and I 2 . The DerSimonian and Laird random-effects model was used in the presence of significant statistical heterogeneity. Publication bias was assessed using a funnel plot with asymmetry measure using Egger test and Begg and Mazumdar test. Analyses were conducted on an intention-to-treat basis. Database of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright © 2017 University of York Page: 1 / 3