Clinical outcomes with bioabsorbable polymer- versus durable polymer-based drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis.

Abstract

OBJECTIVES:

This study sought to investigate the relative safety and efficacy of bioabsorbable polymer (BP)-based biolimus-eluting stents (BES) versus durable-polymer (DP)-drug-eluting stents (DES) and bare-metal stents (BMS) by means of a network meta-analysis.

BACKGROUND:

Studies have suggested that BP-BES might reduce the risk of stent thrombosis (ST) and late adverse outcomes compared with first-generation DES. However, the relative safety and efficacy of BP-BES versus newer-generation DES coated with more biocompatible DP have not been investigated in depth.

METHODS:

Randomized controlled trials comparing BP-BES versus currently U.S.-approved DES or BMS were searched through MEDLINE, EMBASE, and Cochrane databases. Information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted.

RESULTS:

Data from 89 trials including 85,490 patients were analyzed. At 1-year follow-up, BP-BES were associated with lower rates of cardiac death/myocardial infarction (MI), MI, and target vessel revascularization (TVR) than BMS and lower rates of TVR than fast-release zotarolimus-eluting stents. The BP-BES had similar rates of cardiac death/MI, MI, and TVR compared with other second-generation DP-DES but higher rates of 1-year ST than cobalt-chromium everolimus-eluting stents (CoCr-EES). The BP-BES were associated with improved late outcomes compared with BMS and paclitaxel-eluting stents, considering the latest follow-up data available, with nonsignificantly different outcomes compared with other DP-DES although higher rates of definite ST compared with CoCr-EES.

CONCLUSIONS:

In this large-scale network meta-analysis, BP-BES were associated with superior clinical outcomes compared with BMS and first-generation DES and similar rates of cardiac death/MI, MI, and TVR compared with second-generation DP-DES but higher rates of definite ST than CoCr-EES.

• Authors: Tullio Palmerini, Giuseppe Biondi-Zoccai, Diego Della Riva, Andrea Mariani, Manel Sabaté, Pieter C Smits, Christoph Kaiser, Fabrizio D'Ascenzo, Giacomo Frati, Massimo Mancone, Philippe Genereux, Gregg W Stone
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 63 Issue 4 Pg. 299-307 (Feb 04 2014) ISSN: 1558-3597 [Electronic] United States
• PMID: 24211507 (Publication Type: Journal Article, Meta-Analysis, Review)
• Copyright: Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Cardiovascular Agents
• Chromium Alloys
• Coated Materials, Biocompatible
• Polymers
• Everolimus
• zotarolimus
• Paclitaxel
• Sirolimus

Topics

• Cardiovascular Agents (administration & dosage)
• Chromium Alloys
• Coated Materials, Biocompatible
• Coronary Thrombosis (epidemiology, prevention & control)
• Drug-Eluting Stents
• Everolimus
• Humans
• Myocardial Infarction (epidemiology, therapy)
• Myocardial Revascularization (statistics & numerical data)
• Paclitaxel (administration & dosage)
• Polymers
• Randomized Controlled Trials as Topic
• Sirolimus (administration & dosage, analogs & derivatives)
• Stents