Sirolimus-eluting stents compared with standard stents in the treatment of patients with primary angioplasty.

BACKGROUND: Sirolimus-eluting stents have been shown to decrease restenosis and reintervention as compared with standard stents. We evaluated the use of sirolimus-eluting stents in primary percutaneous coronary intervention for acute myocardial infarction with ST-segment elevation. METHODS: We randomly assigned 120 patients to compare sirolimus-eluting stents with uncoated stents in primary percutaneous coronary intervention for acute myocardial infarction with ST-segment elevation. The primary end point was composite: death from cardiac causes, recurrent myocardial infarction, or target-lesion revascularization after 360 days. RESULTS: The rate of the primary end point was 6.7% in the sirolimus-eluting stent and 11% in the bare-metal stent group (relative risk 1.75, 95% CI 0.47-6.57, P = .402). The survival free from target-vessel failure showed a higher trend in the sirolimus-eluting stent group than in the bare-metal stent group (0.0% vs 5.7%, P = .064). There was no significant difference between the 2 groups in the rate of death (5% and 3.6%, respectively; P = .736), reinfarction (1.7% and 1.8%, respectively; P = .940), or stent thrombosis (3.4% and 1.8%, respectively; P = .621). CONCLUSIONS: Among selected patients with acute myocardial infarction and ST-segment elevation, the use of sirolimus-eluting stents shows a trend to reduce the rate of target-vessel revascularization in comparison with bare-metal stent.

Revisión de los resultados de los principales subestudios del estudio RE-LY / Review of the principal RE-LY substudy results

Desde la publicación del estudio Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY), se ha publicado un total de 10 subanálisis de sus datos. La eficacia de dabigatrán a dosis de 110 y 150mg cada 12h comparado con warfarina para prevenir ictus y embolias sistémicas se ha analizado en diferentes contextos. Se han publicado los resultados que demuestran la superioridad de dabigatrán frente a warfarina en relación con el control de anticoagulación de los pacientes, si habían usado previamente warfarina o era la primera vez que la usaban, si habían tenido previamente un ictus o no, si se habían sometido a cardioversión eléctrica o farmacológica, si eran población japonesa, en diferentes franjas de edad de los pacientes y diferentes niveles de riesgo de sufrir un ictus. Además, se ha publicado un análisis farmacocinético de dabigatrán en la población incluida en el estudio RE-LY y dos análisis de coste-beneficio. Los resultados de todos estos estudios aportan más de 200 puntos de factor de impacto y respaldan la superioridad de dabigatrán frente a warfarina para prevenir ictus o embolias sistémicas (AU)

Since the initial publication of the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) study results, a total of 10 subanalyses of RE-LY data have been reported. In particular, the efficacy of administering 110 mg or 150 mg of dabigatran every 12 hours for preventing stroke and systemic embolism has been compared with that of warfarin in different clinical contexts. The study results demonstrate that dabigatran is superior to warfarin in terms of anticoagulation control, irrespective of whether patients had previously used warfarin or were taking it for the first time, whether or not they had previously had a stroke, and whether or not they had undergone electrical or pharmacologic cardioversion. Dabigatran was also found to be superior in Japanese patients, in different age groups and in patients with varying levels of stroke risk. In addition, a pharmacokinetic analysis of dabigatran in the RE-LY study population and two cost-benefit analyses have also been published. Together, these study results have achieved an equivalent impact factor of 200 and provide further evidence that dabigatran is superior to warfarin in the prevention of stroke and systemic embolism (AU)