Long-Term Safety of DES and BMS | Journal Scan

Study Questions:

What is the long-term relative safety and efficacy of different drug-eluting stents (DES) and bare-metal stents (BMS)?

Methods:

The investigators 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. Randomized controlled trials comparing DES to each other or to BMS were searched through MEDLINE, EMBASE, 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 including 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 (CoCr-EES) were associated with lower rates of mortality, definite stent thrombosis (ST), and myocardial infarction (MI) than BMS, paclitaxel-eluting stents (PES), and sirolimus-eluting stents (SES), and less ST than BES. Phosphorylcholine-based zotarolimus-eluting stents (PC-ZES) had lower rates of definite ST than SES, and lower rates of MI than BMS and PES. The late rates of target vessel revascularization (TVR) were reduced with all DES compared to BMS, with CoCr-EES, platinum chromium-EES, SES, and BES also having lower TVR rates than PES.

Conclusions:

The authors concluded that after a median follow-up of 3.8 years, all DES demonstrated superior efficacy compared to BMS.

Perspective:

This network meta-analysis including 52,158 randomized patients at median follow-up of nearly 4 years reports that all DES demonstrated superior efficacy in reducing TVR compared to BMS. Second-generation DES appear to have substantially improved long-term safety and efficacy outcomes compared to first-generation devices. Among the second-generation DES, durable fluoropolymer-based CoCr-EES were associated with the lowest rates of long-term adverse events and maximum efficacy, and may be the preferred DES at this time. Additional prospective studies are indicated to determine whether bioresorbable vascular scaffolds may further lower the risk of late events in patients undergoing percutaneous coronary intervention and stent implantation.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Chromium, Cobalt, Drug-Eluting Stents, Follow-Up Studies, Myocardial Infarction, Paclitaxel, Percutaneous Coronary Intervention, Phosphorylcholine, Platinum, Polymers, Sirolimus, Stents, Thrombosis


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