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J Am Coll Cardiol. 2015 Jun 16;65(23):2496-507. 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.

Author information

1
Unità Operativa di Cardiologia, Policlinico S. Orsola, Bologna, Italy.
2
Oxford Heart Center; Oxford University, Oxford, England.
3
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
4
Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands.
5
Department of Cardiology, Odense University Hospital, Odense, Denmark.
6
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
7
Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands.
8
Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York. Electronic address: gs2184@columbia.edu.

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:

bare-metal stent(s); drug-eluting stent(s); meta-analysis; stent thrombosis

PMID:
26065988
DOI:
10.1016/j.jacc.2015.04.017
[Indexed for MEDLINE]
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