title: Clinical outcomes with bioabsorbable polymer- versus durable polymer-based drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis.
abstract: OBJECTIVE
  This study sought to investigate the relative safety and efficacy of bioabsorbable polymer (BP)-based biolimus-eluting stents (BES) versus durable-polymer (DP)-drug-eluting stents (DES) and bare-metal stents (BMS) by means of a network meta-analysis.
  
  
  BACKGROUND
  Studies have suggested that BP-BES might reduce the risk of stent thrombosis (ST) and late adverse outcomes compared with first-generation DES. However, the relative safety and efficacy of BP-BES versus newer-generation DES coated with more biocompatible DP have not been investigated in depth.
  
  
  METHODS
  Randomized controlled trials comparing BP-BES versus currently U.S.-approved DES or BMS were searched through MEDLINE, EMBASE, and Cochrane databases. Information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted.
  
  
  RESULTS
  Data from 89 trials including 85,490 patients were analyzed. At 1-year follow-up, BP-BES were associated with lower rates of cardiac death/myocardial infarction (MI), MI, and target vessel revascularization (TVR) than BMS and lower rates of TVR than fast-release zotarolimus-eluting stents. The BP-BES had similar rates of cardiac death/MI, MI, and TVR compared with other second-generation DP-DES but higher rates of 1-year ST than cobalt-chromium everolimus-eluting stents (CoCr-EES). The BP-BES were associated with improved late outcomes compared with BMS and paclitaxel-eluting stents, considering the latest follow-up data available, with nonsignificantly different outcomes compared with other DP-DES although higher rates of definite ST compared with CoCr-EES.
  
  
  CONCLUSIONS
  In this large-scale network meta-analysis, BP-BES were associated with superior clinical outcomes compared with BMS and first-generation DES and similar rates of cardiac death/MI, MI, and TVR compared with second-generation DP-DES but higher rates of definite ST than CoCr-EES.
authors.affiliation: Dipartimento Cardiovascolare, Policlinico Sant' Orsola, Bologna, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.affiliation: Dipartimento Cardiovascolare, Policlinico Sant' Orsola, Bologna, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Della Riva
authors.affiliation: Dipartimento Cardiovascolare, Policlinico Sant' Orsola, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mariani
authors.affiliation: Hospital Clinic, Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Sabaté
authors.affiliation: Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands.
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Smits
authors.affiliation: University Hospital Basel, Basel, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Kaiser
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of Angiocardioneurology, IRCCS "Neuromed", Pozzilli (IS), Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Mancone
authors.affiliation: Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Genereux
authors.affiliation: Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York. Electronic address: gs2184@columbia.edu.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D002317:Cardiovascular Agents / Q000008:administration & dosage; D002858:Chromium Alloys; D020099:Coated Materials, Biocompatible; D003328:Coronary Thrombosis / Q000453:epidemiology* / Q000517:prevention & control; D054855:Drug-Eluting Stents; D000068338:Everolimus; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000628:therapy; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D017239:Paclitaxel / Q000008:administration & dosage; D011108:Polymers; D016032:Randomized Controlled Trials as Topic; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D015607:Stents
chemical_list: D002317:Cardiovascular Agents; D002858:Chromium Alloys; D020099:Coated Materials, Biocompatible; D011108:Polymers; D000068338:Everolimus; C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus
keywords: BES; BP; CI; CoCr-EES; DP; OR; PC-ZES; PES; PtCr-EES; RCT; SES; ST; TVR; bare-metal stent(s); bioabsorbable polymers; biolimus-eluting stent(s); cobalt-chromium everolimus-eluting stent(s); credible interval; drug-eluting stent(s); durable polymers; meta-analysis; odds ratio; paclitaxel-eluting stent(s); phosphorylcholine-based zotarolimus-eluting stent(s); platinum chromium everolimus-eluting stent(s); randomized controlled trial; sirolimus-eluting stent(s); stent thrombosis; target vessel revascularizations