Bare-metal stent versus drug-eluting stent in large coronary arteries: meta-analysis of randomized controlled trials.
BACKGROUND
Uncertainties exist with regard to the efficacy of drug-eluting stent (DES) versus bare-metal stent (BMS) in large coronary arteries.


OBJECTIVE
The aim of this study was to investigate the efficacy of BMS versus DES in terms of clinical events in large coronary vessels (≥3.0 mm) by performing a meta-analysis of all relevant randomized controlled trials (RCTs).


RESULTS
Six RCTs with 4,399 patients were included in this study. Overall, there were no significant between-group differences in the risks of the composite of cardiac death and nonfatal myocardial infarction (cardiac death/MI), cardiac death, myocardial infarction, and stent thrombosis, however, DES was associated with significant reduction in the risk of target vessel revascularization (TVR) compared with BMS [0.48 (0.33, 0.70)] with consistent benefits among patients with reference vessel diameter ≥ 3.5 mm, reference vessel diameter ≥ 4.0 mm, stent length ≤ 15 mm, first-generation DES or second-generation DES. In patients with ≥ 3-year follow-up, there were no significant between-group differences in the risk of cardiac death/MI, TVR, cardiac death, myocardial infarction or stent thrombosis.


CONCLUSIONS
This meta-analysis suggests that DES is superior to BMS in terms of adverse cardiac events in large coronary arteries at the mid-term follow-up. The long-term efficacy of newer-generation DES versus BMS in larger coronary arteries is still worth further evaluation.
Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, 510120, China.
Deng-Feng
DF
Geng
Zhe
Z
Meng
Hai-Yan
HY
Yan
Ru-Qiong
RQ
Nie
Jing
J
Deng
Jing-Feng
JF
Wang
D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology / Q000401:mortality; D003328:Coronary Thrombosis / Q000209:etiology / Q000401:mortality; D054855:Drug-Eluting Stents; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D016017:Odds Ratio; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
D008670:Metals