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Mortality in patients undergoing revascularization with paclitaxel eluting devices for infrainguinal peripheral artery disease: Insights from a network meta‐analysis of randomized trials
Author(s) -
Kuno Toshiki,
Ueyama Hiroki,
Mikami Takahisa,
Takagi Hisato,
Numasawa Yohei,
Anzai Hitoshi,
Bangalore Sripal
Publication year - 2020
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.29125
Subject(s) - medicine , angioplasty , paclitaxel , balloon , revascularization , randomized controlled trial , stent , surgery , cardiology , chemotherapy , myocardial infarction
Objectives We aimed to evaluate whether paclitaxel eluting devices increased the risk of death in patients undergoing revascularization for infrainguinal peripheral artery disease using network meta‐analyses. Methods PUBMED and EMBASE were searched through April 2020 for randomized trials in patients with infrainguinal peripheral artery disease who underwent revascularization with or without a paclitaxel eluting device (balloon/stent). Short‐term mortality defined as death at 6–12 months, and long‐term mortality defined as death at >12 months after revascularization. Results Our search identified 57 eligible randomized controlled studies enrolling a total of 9,362 patients comparing seven revascularization strategies (balloon angioplasty vs. bare metal stent vs. covered stent vs. paclitaxel eluting stent vs. other drug eluting stent vs. paclitaxel‐coated balloon vs. bypass surgery). Overall, paclitaxel eluting stent and paclitaxel‐coated balloons did not increase short‐term mortality (eg, vs. balloon angioplasty: paclitaxel‐coated balloon OR [95% CI] 1.21 [0.88–1.66], p = .24; paclitaxel eluting stent OR [95%CI] 1.01 [0.63–1.63], p = .97, respectively). In addition, paclitaxel eluting stent did not show significant increase in long‐term mortality (eg, vs. balloon angioplasty: OR [95%CI] 1.06 [0.70–1.59], p = .79). However, paclitaxel‐coated balloon showed significant increase in long‐term mortality compared to balloon angioplasty and bypass (vs. balloon angioplasty: OR [95% CI] 1.48 [1.06–2.07], p = .021; vs. bypass: OR [95%CI] 1.73 [1.05–2.84], p = .031, respectively). Conclusions In this meta‐analysis of randomized trials, there was no significant increase in mortality with paclitaxel eluting stent, but there was increased risk of long‐term mortality in paclitaxel‐coated balloon for the treatment of infrainguinal peripheral artery disease.