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Meta‐analysis of drug eluting stents compared with bare metal stents in high bleeding risk patients undergoing percutaneous coronary interventions
Author(s) -
Neupane Saroj,
Khawaja Owais,
Edla Sushruth,
Singh Hemindermeet,
Othman Hussein,
Bossone Eduardo,
Yamasaki Hiroshi,
Rosman Howard S.,
Eggebrecht Holger,
Mehta Rajendra H.
Publication year - 2019
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.28045
Subject(s) - medicine , mace , percutaneous coronary intervention , conventional pci , myocardial infarction , randomized controlled trial , discontinuation , stent , relative risk , drug eluting stent , surgery , cardiology , confidence interval
Objectives To determine the efficacy and safety of drug‐eluting stents (DESs) and bare metal stents (BMSs) when used with short or tailored dual antiplatelet therapy (DAPT) in high bleeding risk (HBR) patients. Background DES have been shown to reduce target lesion revascularization (TLR) as well as stent thrombosis (ST) compared to BMS in patients undergoing percutaneous coronary intervention (PCI). However, patients at HBR continue to receive BMS given the fear of bleeding or ST from premature discontinuation of DAPT in patients receiving DES. Methods We performed a meta‐analysis of randomized controlled trials by performing systematic search for studies comparing DES with BMS in HBR patients using PUBMED, MEDLINE, and Cochrane Central, reported until March 1, 2018. Results Three randomized controlled studies met the inclusion criteria with total of 4,460 patients; 50% received DES. Major adverse cardiovascular event (MACE); composite of death, myocardial infarction (MI), and TLR, at 1 year was significantly lower (RR = 0.63, 95% CI 0.50–0.80) in DES group compared to BMS. This difference was primarily driven by lower TLR (RR = 0.46, 95% CI 0.35–0.61) in DES group. Definite or probable ST (RR = 0.59, 95% CI = 0.32–1.08) and major (RR = 0.94, 95% CI = 0.74–1.20) bleeding were similar. Conclusions DES was associated with lower MACE without increased risk of bleeding or ST compared to BMS when used with short or tailored DAPT in patients with HBR.