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Meta‐analysis of bioabsorbable versus durable polymer drug‐eluting stents in 20,005 patients with coronary artery disease: An update
Author(s) -
Lupi Alessandro,
Gabrio Secco Gioel,
Rogi Andrea,
Lazzero Maurizio,
Fattori Rossella,
Sheiban Imad,
Sante Bongo Angelo,
Bolognese Leonardo,
Agostoni Pierfrancesco,
Porto Italo
Publication year - 2014
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25416
Subject(s) - medicine , myocardial infarction , drug eluting stent , stent , cardiology , coronary artery disease , meta analysis , paclitaxel , revascularization , surgery , percutaneous coronary intervention , chemotherapy
Objectives To perform an updated meta‐analysis comparing biodegradable polymer drug eluting stents (BP‐DES) and durable polymer drug eluting stents (DP‐DES). Background BP‐DES have been suggested to reduce late stent thrombosis (LST) rates as compared to first generation DP‐DES. Recently, second generation DP‐DES have replaced older DES, but comparison of these stents with BP‐DES has not yielded consistent results. Methods Medline/Web databases were searched for studies comparing BP‐DES and DP‐DES, and reporting rates of overall/cardiac mortality, myocardial infarction (MI), LST, target lesion revascularization (TLR) and target vessel revascularization (TVR) and late lumen loss (LLL), with a follow‐up ≥6 months. Results Twenty studies (20,005 patients) were included in the meta‐analysis. Median follow‐up time was 1 year. Compared with DP‐DES, BP‐DES showed lower LLL (in stent: weighted mean difference WMD −0.45 mm, 95% CI −0.66 to −0.24 mm, P = 0.00001; in segment: WMD −0.15 mm, 95% CI = −0.24 to −0.06 mm, P = 0.001) and lower rates of LST (OR 0.51, 95% CI = 0.30 to 0.86, P = 0.01), although they did not improve mortality, MI, TLR, and TVR rates. BP‐DES coated with sirolimus or novolimus, in comparison with biolimus or paclitaxel, were associated with reduced LLL ( P < 0.0001 for subgroups). Conclusions In comparison with DP‐DES, BP‐DES significantly reduce LLL and LST rates, without clear benefits on harder endpoints. The efficacy of BP‐DES in preserving lumen patency seems larger for sirolimus and novolimus DES. © 2014 Wiley Periodicals, Inc.