title: Long-Term Safety of Drug-Eluting and Bare-Metal Stents: Evidence From a Comprehensive Network Meta-Analysis.
abstract: BACKGROUND
  Previous meta-analyses have investigated the relative safety and efficacy profiles of different types of drug-eluting stents (DES) and bare-metal stents (BMS); however, most prior trials in these meta-analyses reported follow-up to only 1 year, and as such, the relative long-term safety and efficacy of these devices are unknown. Many recent studies have now reported extended follow-up data.
  
  
  OBJECTIVE
  This study sought to investigate the long-term safety and efficacy of durable polymer-based DES, bioabsorbable polymer-based biolimus-eluting stents (BES), and BMS by means of network meta-analysis.
  
  
  METHODS
  Randomized controlled trials comparing DES to each other or to BMS were searched through MEDLINE, EMBASE, and Cochrane databases and proceedings of international meetings. Information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted.
  
  
  RESULTS
  Fifty-one trials that included a total of 52,158 randomized patients with follow-up duration ≥3 years were analyzed. At a median follow-up of 3.8 years, cobalt-chromium everolimus-eluting stents (EES) were associated with lower rates of mortality, definite stent thrombosis (ST), and myocardial infarction than BMS, paclitaxel-eluting stents (PES), and sirolimus-eluting stents (SES) and less ST than BES. Phosphorylcholine-based zotarolimus-eluting stents had lower rates of definite ST than SES and lower rates of myocardial infarction than BMS and PES. The late rates of target-vessel revascularization were reduced with all DES compared with BMS, with cobalt-chromium EES, platinum chromium-EES, SES, and BES also having lower target-vessel revascularization rates than PES.
  
  
  CONCLUSIONS
  After a median follow-up of 3.8 years, all DES demonstrated superior efficacy compared with BMS. Among DES, second-generation devices have substantially improved long-term safety and efficacy outcomes compared with first-generation devices.
authors.affiliation: Unità Operativa di Cardiologia, Policlinico S. Orsola, Bologna, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.affiliation: Oxford Heart Center; Oxford University, Oxford, England.
authors.forename: Umberto
authors.initials: U
authors.lastname: Benedetto
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: Unità Operativa di Cardiologia, Policlinico S. Orsola, Bologna, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Della Riva
authors.affiliation: Unità Operativa di Cardiologia, Policlinico S. Orsola, Bologna, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Bacchi-Reggiani
authors.affiliation: Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands.
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Smits
authors.affiliation: Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands.
authors.forename: Georgios J
authors.initials: GJ
authors.lastname: Vlachojannis
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Lisette Okkels
authors.initials: LO
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Evald H
authors.initials: EH
authors.lastname: Christiansen
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Klára
authors.initials: K
authors.lastname: Berencsi
authors.affiliation: Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.affiliation: Unità Operativa di Cardiologia, Policlinico S. Orsola, Bologna, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Orlandi
authors.affiliation: Oxford Heart Center; Oxford University, Oxford, England.
authors.forename: Mario
authors.initials: M
authors.lastname: Petrou
authors.affiliation: Unità Operativa di Cardiologia, Policlinico S. Orsola, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
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: D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000639:trends*; D005500:Follow-Up Studies; D006801:Humans; D008670:Metals / Q000009:adverse effects; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000639:trends*; D016032:Randomized Controlled Trials as Topic / Q000639:trends; D015607:Stents / Q000009:adverse effects / Q000639:trends; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: bare-metal stent(s); drug-eluting stent(s); meta-analysis; stent thrombosis