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JACC Cardiovasc Interv. 2014 Jan;7(1):55-63. doi: 10.1016/j.jcin.2013.07.012. Epub 2013 Dec 11.

Comparison of newer-generation drug-eluting with bare-metal stents in patients with acute ST-segment elevation myocardial infarction: a pooled analysis of the EXAMINATION (clinical Evaluation of the Xience-V stent in Acute Myocardial INfArcTION) and COMFORTABLE-AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction) trials.

Author information

  • 1University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
  • 2Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
  • 3Department of Clinical Research, Clinical Trials Unit, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
  • 4University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. Electronic address:
  • 5Cardiac Catheterization Laboratory, Rigshospitalet, Copenhagen, Denmark.
  • 6University Hospital of Bellvitge, Barcelona, Spain.
  • 7Clinical Center of Serbia, Belgrade, Serbia.
  • 8Hospital do Meixoeiro, Vigo, Spain.
  • 9Cardiology Department, Triemlispital, Zurich, Switzerland.
  • 10University Hospital of Sant Pau, Barcelona, Spain.
  • 11Bristol Heart Institute, Bristol, United Kingdom.
  • 12Thoraxcentrum Twente, Twente University, Enschede, the Netherlands.
  • 13University Hospital San Carlos, Madrid, Spain.
  • 14Cardiocentro, Lugano, Switzerland.
  • 15Hospital General of Alicante, Alicante, Spain.
  • 16University Hospital Ferrara, Ferrara, Italy.
  • 17Erasmus Medical Center, Rotterdam, the Netherlands.



This study sought to study the efficacy and safety of newer-generation drug-eluting stents (DES) compared with bare-metal stents (BMS) in an appropriately powered population of patients with ST-segment elevation myocardial infarction (STEMI).


Among patients with STEMI, early generation DES improved efficacy but not safety compared with BMS. Newer-generation DES, everolimus-eluting stents, and biolimus A9-eluting stents, have been shown to improve clinical outcomes compared with early generation DES.


Individual patient data for 2,665 STEMI patients enrolled in 2 large-scale randomized clinical trials comparing newer-generation DES with BMS were pooled: 1,326 patients received a newer-generation DES (everolimus-eluting stent or biolimus A9-eluting stent), whereas the remaining 1,329 patients received a BMS. Random-effects models were used to assess differences between the 2 groups for the device-oriented composite endpoint of cardiac death, target-vessel reinfarction, and target-lesion revascularization and the patient-oriented composite endpoint of all-cause death, any infarction, and any revascularization at 1 year.


Newer-generation DES substantially reduce the risk of the device-oriented composite endpoint compared with BMS at 1 year (relative risk [RR]: 0.58; 95% confidence interval [CI]: 0.43 to 0.79; p = 0.0004). Similarly, the risk of the patient-oriented composite endpoint was lower with newer-generation DES than BMS (RR: 0.78; 95% CI: 0.63 to 0.96; p = 0.02). Differences in favor of newer-generation DES were driven by both a lower risk of repeat revascularization of the target lesion (RR: 0.33; 95% CI: 0.20 to 0.52; p < 0.0001) and a lower risk of target-vessel infarction (RR: 0.36; 95% CI: 0.14 to 0.92; p = 0.03). Newer-generation DES also reduced the risk of definite stent thrombosis (RR: 0.35; 95% CI: 0.16 to 0.75; p = 0.006) compared with BMS.


Among patients with STEMI, newer-generation DES improve safety and efficacy compared with BMS throughout 1 year. It remains to be determined whether the differences in favor of newer-generation DES are sustained during long-term follow-up.


BES; BMS; CI; DES; DOCE; EES; HR; POCE; RR; ST-segment elevation myocardial infarction; STEMI; bare-metal stent(s); biolimus A9–eluting stent(s); confidence interval; device-oriented composite endpoint; drug-eluting stent(s); everolimus-eluting stent(s); hazard ratio; patient-oriented composite endpoint; relative risk; stent thrombosis

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