Long-Term Safety of Drug-Eluting and Bare-Metal Stents: Evidence From a Comprehensive Network Meta-Analysis

Tullio Palmerini; Umberto Benedetto; Giuseppe Biondi-Zoccai; Diego Della Riva; Letizia Bacchi-Reggiani; Pieter C Smits; Georgios J Vlachojannis; Lisette Okkels Jensen; Evald H Christiansen; Klára Berencsi; Marco Valgimigli; Carlotta Orlandi; Mario Petrou; Claudio Rapezzi; Gregg W Stone

doi:10.1016/j.jacc.2015.04.017

Long-Term Safety of Drug-Eluting and Bare-Metal Stents: Evidence From a Comprehensive Network Meta-Analysis

Tullio Palmerini
, Umberto Benedetto
, Giuseppe Biondi-Zoccai
, Diego Della Riva
, Letizia Bacchi-Reggiani
, Pieter C Smits
, Georgios J Vlachojannis
, Lisette Okkels Jensen
, Evald H Christiansen
, Klára Berencsi
, Marco Valgimigli
, Carlotta Orlandi
, Mario Petrou
, Claudio Rapezzi
, Gregg W Stone

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

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.

Original language	English
Pages (from-to)	2496-507
Number of pages	12
Journal	Journal of the American College of Cardiology
Volume	65
Issue number	23
DOIs	https://doi.org/10.1016/j.jacc.2015.04.017
Publication status	Published - 16 Jun 2015
Externally published	Yes

Keywords

Drug-Eluting Stents/adverse effects
Follow-Up Studies
Humans
Metals/adverse effects
Myocardial Infarction/diagnosis
Percutaneous Coronary Intervention/adverse effects
Randomized Controlled Trials as Topic/trends
Stents/adverse effects
Thrombosis/diagnosis
Time Factors
Treatment Outcome

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10.1016/j.jacc.2015.04.017

Cite this

Palmerini, T., Benedetto, U., Biondi-Zoccai, G., Della Riva, D., Bacchi-Reggiani, L., Smits, P. C., Vlachojannis, G. J., Jensen, L. O., Christiansen, E. H., Berencsi, K., Valgimigli, M., Orlandi, C., Petrou, M., Rapezzi, C., & Stone, G. W. (2015). Long-Term Safety of Drug-Eluting and Bare-Metal Stents: Evidence From a Comprehensive Network Meta-Analysis. Journal of the American College of Cardiology, 65(23), 2496-507. https://doi.org/10.1016/j.jacc.2015.04.017

@article{29d3149b26664aef99d713397a46cab4,

title = "Long-Term Safety of Drug-Eluting and Bare-Metal Stents: Evidence From a Comprehensive Network Meta-Analysis",

abstract = "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.",

keywords = "Drug-Eluting Stents/adverse effects, Follow-Up Studies, Humans, Metals/adverse effects, Myocardial Infarction/diagnosis, Percutaneous Coronary Intervention/adverse effects, Randomized Controlled Trials as Topic/trends, Stents/adverse effects, Thrombosis/diagnosis, Time Factors, Treatment Outcome",

author = "Tullio Palmerini and Umberto Benedetto and Giuseppe Biondi-Zoccai and \{Della Riva\}, Diego and Letizia Bacchi-Reggiani and Smits, \{Pieter C\} and Vlachojannis, \{Georgios J\} and Jensen, \{Lisette Okkels\} and Christiansen, \{Evald H\} and Kl{\'a}ra Berencsi and Marco Valgimigli and Carlotta Orlandi and Mario Petrou and Claudio Rapezzi and Stone, \{Gregg W\}",

year = "2015",

month = jun,

day = "16",

doi = "10.1016/j.jacc.2015.04.017",

language = "English",

volume = "65",

pages = "2496--507",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier",

number = "23",

}

Palmerini, T, Benedetto, U, Biondi-Zoccai, G, Della Riva, D, Bacchi-Reggiani, L, Smits, PC, Vlachojannis, GJ, Jensen, LO, Christiansen, EH, Berencsi, K, Valgimigli, M, Orlandi, C, Petrou, M, Rapezzi, C & Stone, GW 2015, 'Long-Term Safety of Drug-Eluting and Bare-Metal Stents: Evidence From a Comprehensive Network Meta-Analysis', Journal of the American College of Cardiology, vol. 65, no. 23, pp. 2496-507. https://doi.org/10.1016/j.jacc.2015.04.017

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

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 -

Long-Term Safety of Drug-Eluting and Bare-Metal Stents: Evidence From a Comprehensive Network Meta-Analysis

Abstract

Keywords

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