Determining clinical benefits of drug-eluting coronary stents according to the population risk profile: a meta-regression from 31 randomized trials.
BACKGROUND
The use of drug-eluting stents (DES) in unfavourable patients has been associated with higher rates of clinical complications and stent thrombosis, and because of that concerns about the use of DES in high-risk settings have been raised.


OBJECTIVE
This study sought to demonstrate that the clinical benefit of DES increases as the risk profile of the patients increases.


METHODS
A meta-regression analysis from 31 randomized trials that compared DES and bare-metal stents, including overall 12,035 patients, was performed. The relationship between the clinical benefit of using DES (number of patients to treat [NNT] to prevent one episode of target lesion revascularization [TLR]), and the risk profile of the population (rate of TLR in patients allocated to bare-metal stents) in each trial was evaluated.


RESULTS
The clinical benefit of DES increased as the risk profile of each study population increased: NNT for TLR=31.1-1.2 (TLR for bare-metal stents); p<0.001. The use of DES was safe regardless of the risk profile of each study population, since the effect of DES in mortality, myocardial infarction, and stent thrombosis, was not adversely affected by the risk profile of each study population (95% confidence interval for β value 0.09 to 0.11, -0.12 to 0.19, and -0.03 to-0.15 for mortality, myocardial infarction, and stent thrombosis, respectively).


CONCLUSIONS
The clinical benefit of DES increases as the risk profile of the patients increases, without affecting safety.
Moreno
Raul
R
University Hospital La Paz, Madrid, Spain. raulmorenog@terra.es
Martin-Reyes
Roberto
R
Jimenez-Valero
Santiago
S
Sanchez-Recalde
Angel
A
Galeote
Guillermo
G
Calvo
Luis
L
Plaza
Ignacio
I
Lopez-Sendon
Jose-Luis
JL
D054855:Drug-Eluting Stents / Q000639:trends; D005500:Follow-Up Studies; D006801:Humans; D011159:Population Surveillance / Q000379:methods; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000639:trends; D012044:Regression Analysis; D012307:Risk Factors