Polymer-free versus permanent polymer-coated drug eluting stents for the treatment of coronary artery disease

A meta-analysis of randomized trials

Jason Nogic, Yi Wei Baey, Nitesh Nerlekar, Francis J. Ha, James D. Cameron, Arthur Nasis, Nick E.J. West, Adam J. Brown

Research output: Contribution to journalArticleResearchpeer-review

3 Citations (Scopus)

Abstract

Background: Polymer-free drug eluting stents (PF-DES) were developed, in part, to overcome risk of late ischemic events observed with permanent polymer-coated DES (PP-DES). However, trial results are inconsistent with longer-term safety and efficacy of PF-DES remaining unknown. We performed a meta-analysis of randomized trials assessing outcomes of patients receiving PF-DES versus PP-DES for treatment of coronary artery disease (CAD). Methods: Electronic searches were performed for randomized trials comparing outcomes between PF-DES and PP-DES. Trials reporting major adverse cardiovascular events (MACE), myocardial infarction (MI), stent thrombosis (ST), all-cause death, target lesion/vessel revascularization (TLR/TVR), and late lumen loss (LLL) were included. Analyses were performed at longest follow-up and landmarked beyond 1-year. Results: Twelve trials (6,943 patients) were included. There was no significant difference in MACE between PF-DES and PP-DES at longest follow-up (Odds Ratio [OR] 0.96, 95%CI 0.85-1.10, P=0.59) or landmark analysis beyond 1-year (OR 0.96, 95%CI 0.76-1.20, P=0.70). Although PF-DES were associated with a significant reduction in all-cause death (OR 0.85, 95%CI 0.72-1.00, P<0.05), this effect was not present on landmark analysis beyond 1-year (OR 0.89, 95%CI 0.73-1.10, P=0.30). There were no differences observed for MI (OR 1.00, 95%CI 0.77-1.28, P=0.99) or ST (OR 0.95, 95%CI 0.54-1.68, P=0.86), with similar efficacy outcomes including TVR (OR 1.07, 95%CI 0.91-1.26, P=0.42), TLR (OR 1.03, 95%CI 0.88-1.21, P=0.68) and angiographic LLL (pooled mean difference 0.01mm, 95%CI -0.08 to 0.11, P=0.76). Conclusions: PF-DES are as safe and efficacious as PP-DES for the treatment of patients with CAD, but do not significantly reduce late ischemic complications.

Original languageEnglish
Number of pages9
JournalJournal of Interventional Cardiology
DOIs
Publication statusAccepted/In press - 1 Dec 2018

Keywords

  • Coronary artery disease
  • Drug-eluting stent
  • Durable-polymer stent
  • Permanent-polymer stent
  • Polymer-free stent

Cite this

@article{0039b1250e624006b548655d77b8fedb,
title = "Polymer-free versus permanent polymer-coated drug eluting stents for the treatment of coronary artery disease: A meta-analysis of randomized trials",
abstract = "Background: Polymer-free drug eluting stents (PF-DES) were developed, in part, to overcome risk of late ischemic events observed with permanent polymer-coated DES (PP-DES). However, trial results are inconsistent with longer-term safety and efficacy of PF-DES remaining unknown. We performed a meta-analysis of randomized trials assessing outcomes of patients receiving PF-DES versus PP-DES for treatment of coronary artery disease (CAD). Methods: Electronic searches were performed for randomized trials comparing outcomes between PF-DES and PP-DES. Trials reporting major adverse cardiovascular events (MACE), myocardial infarction (MI), stent thrombosis (ST), all-cause death, target lesion/vessel revascularization (TLR/TVR), and late lumen loss (LLL) were included. Analyses were performed at longest follow-up and landmarked beyond 1-year. Results: Twelve trials (6,943 patients) were included. There was no significant difference in MACE between PF-DES and PP-DES at longest follow-up (Odds Ratio [OR] 0.96, 95{\%}CI 0.85-1.10, P=0.59) or landmark analysis beyond 1-year (OR 0.96, 95{\%}CI 0.76-1.20, P=0.70). Although PF-DES were associated with a significant reduction in all-cause death (OR 0.85, 95{\%}CI 0.72-1.00, P<0.05), this effect was not present on landmark analysis beyond 1-year (OR 0.89, 95{\%}CI 0.73-1.10, P=0.30). There were no differences observed for MI (OR 1.00, 95{\%}CI 0.77-1.28, P=0.99) or ST (OR 0.95, 95{\%}CI 0.54-1.68, P=0.86), with similar efficacy outcomes including TVR (OR 1.07, 95{\%}CI 0.91-1.26, P=0.42), TLR (OR 1.03, 95{\%}CI 0.88-1.21, P=0.68) and angiographic LLL (pooled mean difference 0.01mm, 95{\%}CI -0.08 to 0.11, P=0.76). Conclusions: PF-DES are as safe and efficacious as PP-DES for the treatment of patients with CAD, but do not significantly reduce late ischemic complications.",
keywords = "Coronary artery disease, Drug-eluting stent, Durable-polymer stent, Permanent-polymer stent, Polymer-free stent",
author = "Jason Nogic and Baey, {Yi Wei} and Nitesh Nerlekar and Ha, {Francis J.} and Cameron, {James D.} and Arthur Nasis and West, {Nick E.J.} and Brown, {Adam J.}",
year = "2018",
month = "12",
day = "1",
doi = "10.1111/joic.12522",
language = "English",
journal = "Journal of Interventional Cardiology: An international forum for global cardiovascular therapies",
issn = "0896-4327",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Polymer-free versus permanent polymer-coated drug eluting stents for the treatment of coronary artery disease

T2 - A meta-analysis of randomized trials

AU - Nogic, Jason

AU - Baey, Yi Wei

AU - Nerlekar, Nitesh

AU - Ha, Francis J.

AU - Cameron, James D.

AU - Nasis, Arthur

AU - West, Nick E.J.

AU - Brown, Adam J.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background: Polymer-free drug eluting stents (PF-DES) were developed, in part, to overcome risk of late ischemic events observed with permanent polymer-coated DES (PP-DES). However, trial results are inconsistent with longer-term safety and efficacy of PF-DES remaining unknown. We performed a meta-analysis of randomized trials assessing outcomes of patients receiving PF-DES versus PP-DES for treatment of coronary artery disease (CAD). Methods: Electronic searches were performed for randomized trials comparing outcomes between PF-DES and PP-DES. Trials reporting major adverse cardiovascular events (MACE), myocardial infarction (MI), stent thrombosis (ST), all-cause death, target lesion/vessel revascularization (TLR/TVR), and late lumen loss (LLL) were included. Analyses were performed at longest follow-up and landmarked beyond 1-year. Results: Twelve trials (6,943 patients) were included. There was no significant difference in MACE between PF-DES and PP-DES at longest follow-up (Odds Ratio [OR] 0.96, 95%CI 0.85-1.10, P=0.59) or landmark analysis beyond 1-year (OR 0.96, 95%CI 0.76-1.20, P=0.70). Although PF-DES were associated with a significant reduction in all-cause death (OR 0.85, 95%CI 0.72-1.00, P<0.05), this effect was not present on landmark analysis beyond 1-year (OR 0.89, 95%CI 0.73-1.10, P=0.30). There were no differences observed for MI (OR 1.00, 95%CI 0.77-1.28, P=0.99) or ST (OR 0.95, 95%CI 0.54-1.68, P=0.86), with similar efficacy outcomes including TVR (OR 1.07, 95%CI 0.91-1.26, P=0.42), TLR (OR 1.03, 95%CI 0.88-1.21, P=0.68) and angiographic LLL (pooled mean difference 0.01mm, 95%CI -0.08 to 0.11, P=0.76). Conclusions: PF-DES are as safe and efficacious as PP-DES for the treatment of patients with CAD, but do not significantly reduce late ischemic complications.

AB - Background: Polymer-free drug eluting stents (PF-DES) were developed, in part, to overcome risk of late ischemic events observed with permanent polymer-coated DES (PP-DES). However, trial results are inconsistent with longer-term safety and efficacy of PF-DES remaining unknown. We performed a meta-analysis of randomized trials assessing outcomes of patients receiving PF-DES versus PP-DES for treatment of coronary artery disease (CAD). Methods: Electronic searches were performed for randomized trials comparing outcomes between PF-DES and PP-DES. Trials reporting major adverse cardiovascular events (MACE), myocardial infarction (MI), stent thrombosis (ST), all-cause death, target lesion/vessel revascularization (TLR/TVR), and late lumen loss (LLL) were included. Analyses were performed at longest follow-up and landmarked beyond 1-year. Results: Twelve trials (6,943 patients) were included. There was no significant difference in MACE between PF-DES and PP-DES at longest follow-up (Odds Ratio [OR] 0.96, 95%CI 0.85-1.10, P=0.59) or landmark analysis beyond 1-year (OR 0.96, 95%CI 0.76-1.20, P=0.70). Although PF-DES were associated with a significant reduction in all-cause death (OR 0.85, 95%CI 0.72-1.00, P<0.05), this effect was not present on landmark analysis beyond 1-year (OR 0.89, 95%CI 0.73-1.10, P=0.30). There were no differences observed for MI (OR 1.00, 95%CI 0.77-1.28, P=0.99) or ST (OR 0.95, 95%CI 0.54-1.68, P=0.86), with similar efficacy outcomes including TVR (OR 1.07, 95%CI 0.91-1.26, P=0.42), TLR (OR 1.03, 95%CI 0.88-1.21, P=0.68) and angiographic LLL (pooled mean difference 0.01mm, 95%CI -0.08 to 0.11, P=0.76). Conclusions: PF-DES are as safe and efficacious as PP-DES for the treatment of patients with CAD, but do not significantly reduce late ischemic complications.

KW - Coronary artery disease

KW - Drug-eluting stent

KW - Durable-polymer stent

KW - Permanent-polymer stent

KW - Polymer-free stent

UR - http://www.scopus.com/inward/record.url?scp=85047450326&partnerID=8YFLogxK

U2 - 10.1111/joic.12522

DO - 10.1111/joic.12522

M3 - Article

JO - Journal of Interventional Cardiology: An international forum for global cardiovascular therapies

JF - Journal of Interventional Cardiology: An international forum for global cardiovascular therapies

SN - 0896-4327

ER -