Impact of design of coronary stents and length of dual antiplatelet therapies on ischaemic and bleeding events: a network meta-analysis of 64 randomized controlled trials and 102 735 patients

Fabrizio D'Ascenzo, Mario Iannaccone, Gaelle Saint-Hilary, Maurizio Bertaina, Stefanie Schulz-Schüpke, Cheol Wahn Lee, Alaide Chieffo, Gerard Helft, Sebastiano Gili, Umberto Barbero, Giuseppe Biondi Zoccai, Claudio Moretti, Fabrizio Ugo, Maurizio D'Amico, Roberto Garbo, Gregg Stone, Sara Rettegno, Pierluigi Omedè, Federico Conrotto, Christian TemplinAntonio Colombo, Seung-Jung Park, Adnan Kastrati, David Hildick-Smith, Mauro Gasparini, Fiorenzo Gaita

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: The differential impact on ischaemic and bleeding events of the type of drug-eluting stent [durable polymer stents [DES] vs. biodegradable polymer stents vs. bioresorbable scaffolds (BRS)] and length of dual antiplatelet therapy (DAPT) remains to be defined.

Methods and results: Randomized controlled trials comparing different types of DES and/or DAPT durations were selected. The primary endpoint was Major Adverse Cardiovascular Events (MACE) [a composite of death, myocardial infarction (MI), and target vessel revascularization]. Definite stent thrombosis (ST) and single components of MACE were secondary endpoints. The arms of interest were: BRS with 12 months of DAPT (12mDAPT), biodegradable polymer stent with 12mDAPT, durable polymer stent [everolimus-eluting (EES), zotarolimus-eluting (ZES)] with 12mDAPT, EES/ZES with <12 months of DAPT, and EES/ZES with >12 months of DAPT (DAPT > 12 m). Sixty-four studies with 150 arms and 102 735 patients were included. After a median follow-up of 20 months, MACE rates were similar in the different arms of interest. EES/ZES with DAPT > 12 m reported a lower incidence of MI than the other groups, while BRS showed a higher rate of ST when compared to EES/ZES, irrespective of DAPT length. A higher risk of major bleedings was observed for DAPT > 12 m as compared to shorter DAPT.

Conclusion: Durable and biodegradable polymer stents along with BRS report a similar rate of MACE irrespective of DAPT length. Fewer MI are observed with EES/ZES with DAPT > 12 m, while a higher rate of ST is reported for BRS when compared to EES/ZES, independently from DAPT length. Stent type may partially affect the outcome together with DAPT length.

Original languageEnglish
Pages (from-to)3160-3172
Number of pages13
JournalEuropean Heart Journal
Volume38
Issue number42
DOIs
Publication statusPublished - Nov 7 2017

Keywords

  • Journal Article

Fingerprint Dive into the research topics of 'Impact of design of coronary stents and length of dual antiplatelet therapies on ischaemic and bleeding events: a network meta-analysis of 64 randomized controlled trials and 102 735 patients'. Together they form a unique fingerprint.

Cite this