Biodegradable-polymer drug-eluting stents vs. bare metal stents vs. durable-polymer drug-eluting stents: a systematic review and Bayesian approach network meta-analysis.
BACKGROUND
The aim of this study was to compare the safety and efficacy of biodegradable-polymer (BP) drug-eluting stents (DES), bare metal stents (BMS), and durable-polymer DES in patients undergoing coronary revascularization, we performed a systematic review and network meta-analysis using a Bayesian framework.


RESULTS
Study stents included BMS, paclitaxel-eluting (PES), sirolimus-eluting (SES), endeavor zotarolimus-eluting (ZES-E), cobalt-chromium everolimus-eluting (CoCr-EES), platinium-chromium everolimus-eluting (PtCr-EES), resolute zotarolimus-eluting (ZES-R), and BP biolimus-eluting stents (BP-BES). After a systematic electronic search, 113 trials with 90 584 patients were selected. The principal endpoint was definite or probable stent thrombosis (ST) defined according to the Academic Research Consortium within 1 year.


RESULTS
Biodegradable polymer-biolimus-eluting stents [OR, 0.56; 95% credible interval (CrI), 0.33-0.90], SES (OR, 0.53; 95% CrI, 0.38-0.73), CoCr-EES (OR, 0.34; 95% CrI, 0.23-0.52), and PtCr-EES (OR, 0.31; 95% CrI, 0.10-0.90) were all superior to BMS in terms of definite or probable ST within 1 year. Cobalt-chromium everolimus-eluting stents demonstrated the lowest risk of ST of all stents at all times after stent implantation. Biodegradable polymer-biolimus-eluting stents was associated with a higher risk of definite or probable ST than CoCr-EES (OR, 1.72; 95% CrI, 1.04-2.98). All DES reduced the need for repeat revascularization, and all but PES reduced the risk of myocardial infarction compared with BMS.


CONCLUSIONS
All DESs but PES and ZES-E were superior to BMS in terms of ST within 1 year. Cobalt-chromium everolimus-eluting stents was safer than any DES even including BP-BES. Our results suggest that not only the biodegradability of polymer, but the optimal combination of stent alloy, design, strut thickness, polymer, and drug all combined determine the safety of DES.
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 28 Yeongeon-Dong, Chongno-gu, Seoul 110-744, Korea.
Si-Hyuck
SH
Kang
Kyung Woo
KW
Park
Do-Yoon
DY
Kang
Woo-Hyun
WH
Lim
Kyung Taek
KT
Park
Jung-Kyu
JK
Han
Hyun-Jae
HJ
Kang
Bon-Kwon
BK
Koo
Byung-Hee
BH
Oh
Young-Bae
YB
Park
David E
DE
Kandzari
David J
DJ
Cohen
Seung-Sik
SS
Hwang
Hyo-Soo
HS
Kim
D020341:Absorbable Implants; D001499:Bayes Theorem; D054855:Drug-Eluting Stents; D000068338:Everolimus; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D009204:Myocardial Revascularization / Q000379:methods; D017239:Paclitaxel / Q000008:administration & dosage; D011475:Prosthesis Failure; D016032:Randomized Controlled Trials as Topic; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D015607:Stents; D050257:Tubulin Modulators / Q000008:administration & dosage
D050257:Tubulin Modulators; D000068338:Everolimus; C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus
Bare metal stents; Biodegradable polymer drug-eluting stents; Drug-eluting stents; Meta-analysis