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Stent Thrombosis With Drug-Eluting and Bare-Metal Stents: Evidence From a Comprehensive Network Meta-Analysis
Study Questions:
What is the risk of stent thrombosis between bare-metal and drug-eluting stents (DES)?
Methods:
For this network meta-analysis, randomized controlled trials comparing different DES or drug-eluting with bare-metal stents currently approved in the USA were identified through Medline, Embase, Cochrane databases, and proceedings of international meetings. Information about study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted.
Results:
Forty-nine trials including 50,844 patients randomly assigned to treatment groups were analyzed. One-year definite stent thrombosis was significantly lower with cobalt-chromium everolimus-eluting stents (CoCr-EES) than with bare-metal stents (odds ratio [OR], 0.23; 95% CI, 0.13-0.41). The significant difference in stent thrombosis between CoCr-EES and bare-metal stents was evident as early as 30 days (OR, 0.21; 95% CI, 0.11-0.42) and was also significant between 31 days and 1 year (OR, 0.27; 95% CI, 0.08-0.74). CoCr-EES were also associated with significantly lower rates of 1-year definite stent thrombosis compared with paclitaxel-eluting stents (PES) (OR, 0.28; 95% CI, 0.16-0.48), permanent polymer-based sirolimus-eluting stents (SES) (OR, 0.41; 95% CI, 0.24-0.70), phosphorylcholine-based zotarolimus-eluting stents (ZES) (OR, 0.21; 95% CI, 0.10-0.44), and Resolute ZES (OR, 0.14; 95% CI, 0.03-0.47). At 2-year follow-up, CoCr-EES were still associated with significantly lower rates of definite stent thrombosis than were bare-metal (OR, 0.35; 95% CI, 0.17-0.69) and PES (OR, 0.34; 95% CI, 0.19-0.62). No other DES had lower definite thrombosis rates compared with bare-metal stents at 2-year follow-up.
Conclusions:
The authors concluded that CoCr-EES has the lowest rate of stent thrombosis within 2 years of implantation.
Perspective:
This study reports that CoCr-EES were associated with significantly lower rates of 1-year and 2-year definite stent thrombosis than were bare-metal stents, a result not present with other DES; the reduction in stent thrombosis with CoCr-EES compared with bare-metal stents was apparent both early and late (occurring before 30 days and between 31 days and 1 year); and CoCr-EES were also associated with significantly lower 1-year rates of definite stent thrombosis than were other first- and second-generation DES, including PES, SES, PC-ZES, and Re-ZES. Although the susceptibility to thrombosis is only one component of the overall safety and efficacy profile of DES, based on totality of evidence, CoCr-EES appear to be the preferred DES at this time.
Keywords: Odds Ratio, Follow-Up Studies, Coronary Restenosis, Cobalt, Drug-Eluting Stents, Sirolimus, Angioplasty, Paclitaxel, Coronary Angiography, Thrombosis, Polymers, Chromium, Phosphorylcholine
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