{"id":28499,"date":"2012-04-24T10:03:57","date_gmt":"2012-04-24T14:03:57","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=interventional&p=28499"},"modified":"2012-04-24T10:03:57","modified_gmt":"2012-04-24T14:03:57","slug":"primary-pci-meta-analysis-mortality-trumps-all","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/04\/24\/primary-pci-meta-analysis-mortality-trumps-all\/","title":{"rendered":"Primary PCI Meta-Analysis: Mortality Trumps All"},"content":{"rendered":"

In a new meta-analysis<\/a>\u00a0Dr. Gregg Stone and\u00a0members of the Drug-Eluting Stent in Primary Angioplasty (DESERT) Cooperation concluded that reduction in\u00a0target-vessel revascularization (TVR) associated with\u00a0drug-eluting stents (DES) in primary PCI provided a powerful reason for continued use of DES in primary PCI. An accompanying editorial<\/a>\u00a0by James Brophy focused on several potential DES weaknesses in the study. (Click here<\/a> for our CardioExchange news story.)\u00a0In this post Dr. Stone responds to the editorial.<\/em><\/p>\n

The editorialist makes valid points about the precision that can be achieved from any meta-analysis, including ours. He ignores, however, that the reduction in TVR is robust, and the trend toward a reduction in mortality (with no evidence of a late risk for death) favors the interpretation that DES should be favored in STEMI. Many MIs are small and not of prognostic importance, and very late stent thromboses may not carry the prognostic import of earlier such events. Mortality thus trumps all. Moreover, these data were generated with first generation DES, and the network meta-analysis we recently published in the Lancet<\/a> suggest that newer DES, especially fluoropolymer-based everolimus-eluting stents, may have lower rates of definite stent thrombosis than not only first generation DES, but also BMS. However, all meta-analyses are hypothesis-generating, and require testing in adequately powered randomized trials before being accepted as definitive. Clinical equipoise continues to be present in the clinical community regarding the utility of DES vs BMS in STEMI. Thus, later this year we will be initiating the HORIZONS-AMI II trial, in which 7,000 \u2013 10,000 patients with STEMI will be randomized to PROMUS Element everolimus-eluting stents vs BMS, with this study powered to demonstrate not only improved clinical outcomes but a reduction in stent thrombosis with DES compared to BMS. If positive, this demonstration will truly be paradigm shifting.<\/p>\n","protected":false},"excerpt":{"rendered":"

In a new meta-analysis\u00a0Dr. Gregg Stone and\u00a0members of the Drug-Eluting Stent in Primary Angioplasty (DESERT) Cooperation concluded that reduction in\u00a0target-vessel revascularization (TVR) associated with\u00a0drug-eluting stents (DES) in primary PCI provided a powerful reason for continued use of DES in primary PCI. An accompanying editorial\u00a0by James Brophy focused on several potential DES weaknesses in the study. […]<\/p>\n","protected":false},"author":766,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[945,821,302,437],"class_list":["post-28499","post","type-post","status-publish","format-standard","hentry","category-interventional-cardiology","tag-bare-metal-stents","tag-drug-eluting-stents","tag-primary-pci","tag-stents"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/28499","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/766"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=28499"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/28499\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=28499"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=28499"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=28499"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}