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Eur Heart J. 2017 Nov 7;38(42):3160-3172. doi: 10.1093/eurheartj/ehx437.

Impact of design of coronary stents and length of dual antiplatelet therapies on ischaemic and bleeding events: a network meta-analysis of 64 randomized controlled trials and 102 735 patients.

Author information

1
Department of Cardiology, Città Della Salute e della Scienza Hospital, Corso Bramante 88/90, 10126 Turin, Italy.
2
Department of Cardiology, San Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, 10154 Turin, Italy.
3
Department of Mathematical Sciences "G. L. Lagrange", Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy.
4
Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München Lazarettstrasse 36, Munich 80636, Germany.
5
Department of Cardiology, The Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
6
Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina Milano, 60, 20132 Milan, Italy.
7
Department of Cardiology, Cardiology Institute, Pitié-Salpêtrière Hospital, UPMC, APHP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
8
Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland.
9
Department of Cardiology, La Sapienza, Piazzale Aldo Moro, 5, 00185 Rome, Italy.
10
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso Della Repubblica 79, 04100 Latina, Italy.
11
Department of AngioCardioNeurology, IRCCS Neuromed, Via Atinense, 18, 86077 Pozzilli, Italy.
12
Department of Cardiology, Columbia University Medical Center, USA Cardiovascular Research Foundation, 161 Ft. Washington Ave. Herbert Irving Pavilion 6th Floor, New York, NY 10032 212.305.7060, USA.
13
Department of Cardiology, Sussex Cardiac Centre, Barry Building, Eastern Rd, Brighton BN2 5BE, UK.

Abstract

Aims:

The differential impact on ischaemic and bleeding events of the type of drug-eluting stent [durable polymer stents [DES] vs. biodegradable polymer stents vs. bioresorbable scaffolds (BRS)] and length of dual antiplatelet therapy (DAPT) remains to be defined.

Methods and results:

Randomized controlled trials comparing different types of DES and/or DAPT durations were selected. The primary endpoint was Major Adverse Cardiovascular Events (MACE) [a composite of death, myocardial infarction (MI), and target vessel revascularization]. Definite stent thrombosis (ST) and single components of MACE were secondary endpoints. The arms of interest were: BRS with 12 months of DAPT (12mDAPT), biodegradable polymer stent with 12mDAPT, durable polymer stent [everolimus-eluting (EES), zotarolimus-eluting (ZES)] with 12mDAPT, EES/ZES with <12 months of DAPT, and EES/ZES with >12 months of DAPT (DAPT > 12 m). Sixty-four studies with 150 arms and 102 735 patients were included. After a median follow-up of 20 months, MACE rates were similar in the different arms of interest. EES/ZES with DAPT > 12 m reported a lower incidence of MI than the other groups, while BRS showed a higher rate of ST when compared to EES/ZES, irrespective of DAPT length. A higher risk of major bleedings was observed for DAPT > 12 m as compared to shorter DAPT.

Conclusion:

Durable and biodegradable polymer stents along with BRS report a similar rate of MACE irrespective of DAPT length. Fewer MI are observed with EES/ZES with DAPT > 12 m, while a higher rate of ST is reported for BRS when compared to EES/ZES, independently from DAPT length. Stent type may partially affect the outcome together with DAPT length.

KEYWORDS:

BRS DES EES ZES; DAPT; DAPT duration; Length of dual antiplatelet therapy; Network meta-analysis; Percutaneous coronary intervention; Stents

PMID:
29020300
DOI:
10.1093/eurheartj/ehx437
[Indexed for MEDLINE]

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