Efficacy and safety of drug-eluting stents in chronic total coronary occlusion recanalization: a systematic review and meta-analysis.
OBJECTIVE
The aim of this study was to compare the efficacy and safety of drug-eluting stent (DES) and bare-metal stent (BMS) use in chronic total occlusion (CTO) recanalization.


BACKGROUND
The long-term effectiveness and safety of DES use in CTO recanalization are unclear, and performance of randomized clinical trials in the field is complex.


METHODS
Major electronic information sources were explored for articles comparing outcomes with DES and BMS use among patients with CTO. Assessed clinical outcomes were death, myocardial infarction, target vessel revascularization, major adverse cardiac events, and stent thrombosis; angiographic outcomes were stent restenosis and stent reocclusion.


RESULTS
Fourteen comparative studies were identified (a total of 4,394 patients). When compared with BMS, DES significantly reduced risk of major adverse cardiac events (relative risk [RR]: 0.45, 95% confidence interval [CI]: 0.34 to 0.60, p < 0.001) and TVR (RR: 0.40, 95% CI: 0.28 to 0.58, p < 0.001) without increasing death (RR: 0.87, 95% CI: 0.66 to 1.16, p = 0.88) or myocardial infarction (RR: 0.89, 95% CI: 0.54 to 1.46, p = 0.80). This benefit was sustained at >/=3 years of follow-up. Lower RRs for restenosis (RR: 0.25, 95% CI: 0.16 to 0.41, p < 0.001) and stent reocclusion (RR: 0.30, 95% CI: 0.18 to 0.49, p < 0.001) were also observed in the DES group. A strong trend toward a higher rate of stent thrombosis was documented in DES-treated patients (RR: 2.79, 95% CI: 0.98 to 7.97, p = 0.06).


CONCLUSIONS
DES use in CTO recanalization is associated with significantly fewer major adverse cardiac events and fewer occurrences of target vessel revascularization, restenosis, and stent reocclusion than with BMS. Although a statistical trend toward a higher risk of stent thrombosis was observed, the use of DES in this context seems to be safe, with an overall benefit sustained in the long term.
Colmenarez
Humberto J
HJ
Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
Escaned
Javier
J
Fernández
Cristina
C
Lobo
Liliana
L
Cano
Sara
S
del Angel
Juan G
JG
Alfonso
Fernando
F
Jimenez
Pilar
P
Bañuelos
Camino
C
Gonzalo
Nieves
N
García
Eulogio
E
Hernández
Rosana
R
Macaya
Carlos
C
D054059:Coronary Occlusion / Q000628:therapy*; D054855:Drug-Eluting Stents; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015607:Stents / Q000009:adverse effects