TY - JOUR
T1 - Long-Term Safety of Drug-Eluting and Bare-Metal Stents
T2 - Evidence From a Comprehensive Network Meta-Analysis
AU - Palmerini, Tullio
AU - Benedetto, Umberto
AU - Biondi-Zoccai, Giuseppe
AU - Della Riva, Diego
AU - Bacchi-Reggiani, Letizia
AU - Smits, Pieter C
AU - Vlachojannis, Georgios J
AU - Jensen, Lisette Okkels
AU - Christiansen, Evald H
AU - Berencsi, Klára
AU - Valgimigli, Marco
AU - Orlandi, Carlotta
AU - Petrou, Mario
AU - Rapezzi, Claudio
AU - Stone, Gregg W
N1 - Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2015/6/16
Y1 - 2015/6/16
N2 - BACKGROUND: Previous meta-analyses have investigated the relative safety and efficacy profiles of different types of drug-eluting stents (DES) and bare-metal stents (BMS); however, most prior trials in these meta-analyses reported follow-up to only 1 year, and as such, the relative long-term safety and efficacy of these devices are unknown. Many recent studies have now reported extended follow-up data.OBJECTIVES: This study sought to investigate the long-term safety and efficacy of durable polymer-based DES, bioabsorbable polymer-based biolimus-eluting stents (BES), and BMS by means of network meta-analysis.METHODS: Randomized controlled trials comparing DES to each other or to BMS were searched through MEDLINE, EMBASE, and Cochrane databases and proceedings of international meetings. Information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted.RESULTS: Fifty-one trials that included a total of 52,158 randomized patients with follow-up duration ≥3 years were analyzed. At a median follow-up of 3.8 years, cobalt-chromium everolimus-eluting stents (EES) were associated with lower rates of mortality, definite stent thrombosis (ST), and myocardial infarction than BMS, paclitaxel-eluting stents (PES), and sirolimus-eluting stents (SES) and less ST than BES. Phosphorylcholine-based zotarolimus-eluting stents had lower rates of definite ST than SES and lower rates of myocardial infarction than BMS and PES. The late rates of target-vessel revascularization were reduced with all DES compared with BMS, with cobalt-chromium EES, platinum chromium-EES, SES, and BES also having lower target-vessel revascularization rates than PES.CONCLUSIONS: After a median follow-up of 3.8 years, all DES demonstrated superior efficacy compared with BMS. Among DES, second-generation devices have substantially improved long-term safety and efficacy outcomes compared with first-generation devices.
AB - BACKGROUND: Previous meta-analyses have investigated the relative safety and efficacy profiles of different types of drug-eluting stents (DES) and bare-metal stents (BMS); however, most prior trials in these meta-analyses reported follow-up to only 1 year, and as such, the relative long-term safety and efficacy of these devices are unknown. Many recent studies have now reported extended follow-up data.OBJECTIVES: This study sought to investigate the long-term safety and efficacy of durable polymer-based DES, bioabsorbable polymer-based biolimus-eluting stents (BES), and BMS by means of network meta-analysis.METHODS: Randomized controlled trials comparing DES to each other or to BMS were searched through MEDLINE, EMBASE, and Cochrane databases and proceedings of international meetings. Information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted.RESULTS: Fifty-one trials that included a total of 52,158 randomized patients with follow-up duration ≥3 years were analyzed. At a median follow-up of 3.8 years, cobalt-chromium everolimus-eluting stents (EES) were associated with lower rates of mortality, definite stent thrombosis (ST), and myocardial infarction than BMS, paclitaxel-eluting stents (PES), and sirolimus-eluting stents (SES) and less ST than BES. Phosphorylcholine-based zotarolimus-eluting stents had lower rates of definite ST than SES and lower rates of myocardial infarction than BMS and PES. The late rates of target-vessel revascularization were reduced with all DES compared with BMS, with cobalt-chromium EES, platinum chromium-EES, SES, and BES also having lower target-vessel revascularization rates than PES.CONCLUSIONS: After a median follow-up of 3.8 years, all DES demonstrated superior efficacy compared with BMS. Among DES, second-generation devices have substantially improved long-term safety and efficacy outcomes compared with first-generation devices.
KW - Drug-Eluting Stents/adverse effects
KW - Follow-Up Studies
KW - Humans
KW - Metals/adverse effects
KW - Myocardial Infarction/diagnosis
KW - Percutaneous Coronary Intervention/adverse effects
KW - Randomized Controlled Trials as Topic/trends
KW - Stents/adverse effects
KW - Thrombosis/diagnosis
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1016/j.jacc.2015.04.017
DO - 10.1016/j.jacc.2015.04.017
M3 - Article
C2 - 26065988
SN - 0735-1097
VL - 65
SP - 2496
EP - 2507
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 23
ER -