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

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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
Pages (from-to)608-616
Number of pages9
JournalJournal of Interventional Cardiology
Volume31
Issue number5
DOIs
Publication statusPublished - Oct 2018

Keywords

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

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