title: Impact of biodegradable versus durable polymer drug-eluting stents on clinical outcomes in patients with coronary artery disease: a meta-analysis of 15 randomized trials.
abstract: BACKGROUND
  Drug eluting stents (DESs) made with biodegradable polymer have been developed in an attempt to improve clinical outcomes. However, the impact of biodegradable polymers on clinical events and stent thrombosis (ST) remains controversial.
  
  
  METHODS
  We searched Medline, the Cochrane Library and other internet sources, without language or date restrictions for articles comparing clinical outcomes between biodegradable polymer DES and durable polymer DES. Safety endpoints were ST (definite, definite/probable), mortality, and myocardial infarction (MI). Efficacy endpoints were major adverse cardiac event (MACE) and target lesion revascularization (TLR).
  
  
  RESULTS
  We identified 15 randomized controlled trials (n = 17 068) with a weighted mean follow-up of 20.6 months. There was no statistical difference in the incidence of definite/probable ST between durable polymer- and biodegradable polymer- DES; relative risk (RR) 0.83; 95% confidence interval (CI) 0.62-1.11; P = 0.22. Biodegradable polymer DES had similar rates of definite ST (RR 0.94, 95% CI 0.66-1.33, P = 0.72), mortality (RR 0.94, 95% CI 0.82-1.09, P = 0.43), MI (RR 1.08, 95% CI 0.92-1.26. P = 0.35), MACE (RR 0.99, 95% CI 0.91-1.09, P = 0.85), and TLR (RR, 0.94, 95% CI 0.83-1.06, P = 0.30) compared with durable polymer DES. Based on the stratified analysis of the included trials, the treatment effect on definite ST was different at different follow-up times: ≤ 1 year favoring durable polymer DES and >1 year favoring biodegradable polymer DES.
  
  
  CONCLUSIONS
  Biodegradable polymer DES has similar safety and efficacy for treating patients with coronary artery disease compared with durable polymer DES. Further data with longer term follow-up are warranted to confirm the potential benefits of biodegradable polymer DES.
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, 3015CE, The Netherlands.
authors.forename: Yaojun
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China.
authors.forename: Nailiang
authors.initials: N
authors.lastname: Tian
authors.affiliation: Soochow University, Suzhou, Jiangsu 215021, China.
authors.forename: Shengjie
authors.initials: S
authors.lastname: Dong
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Ye
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China.
authors.forename: Minghui
authors.initials: M
authors.lastname: Li
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, 3015CE, The Netherlands.
authors.forename: Christos V
authors.initials: CV
authors.lastname: Bourantas
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, 3015CE, The Netherlands.
authors.forename: Javaid
authors.initials: J
authors.lastname: Iqbal
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, 3015CE, The Netherlands.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, 3015CE, The Netherlands.
authors.forename: Takashi
authors.initials: T
authors.lastname: Muramatsu
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, 3015CE, The Netherlands.
authors.forename: Roberto
authors.initials: R
authors.lastname: Diletti
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, 3015CE, The Netherlands.
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia-Garcia
authors.affiliation: Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases of China, Beijing 100037, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, 3015CE, The Netherlands.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China. Email: chmengx126@gmail.com.
authors.forename: Shaoliang
authors.initials: S
authors.lastname: Chen
mesh_terms: D003324:Coronary Artery Disease / Q000188:drug therapy / Q000601:surgery*; D054855:Drug-Eluting Stents; D006801:Humans; D011108:Polymers / Q000008:administration & dosage; D013927:Thrombosis
chemical_list: D011108:Polymers