TY - JOUR
T1 - Impact of design of coronary stents and length of dual antiplatelet therapies on ischaemic and bleeding events
T2 - a network meta-analysis of 64 randomized controlled trials and 102 735 patients
AU - D'Ascenzo, Fabrizio
AU - Iannaccone, Mario
AU - Saint-Hilary, Gaelle
AU - Bertaina, Maurizio
AU - Schulz-Schüpke, Stefanie
AU - Wahn Lee, Cheol
AU - Chieffo, Alaide
AU - Helft, Gerard
AU - Gili, Sebastiano
AU - Barbero, Umberto
AU - Biondi Zoccai, Giuseppe
AU - Moretti, Claudio
AU - Ugo, Fabrizio
AU - D'Amico, Maurizio
AU - Garbo, Roberto
AU - Stone, Gregg
AU - Rettegno, Sara
AU - Omedè, Pierluigi
AU - Conrotto, Federico
AU - Templin, Christian
AU - Colombo, Antonio
AU - Park, Seung-Jung
AU - Kastrati, Adnan
AU - Hildick-Smith, David
AU - Gasparini, Mauro
AU - Gaita, Fiorenzo
PY - 2017/11/7
Y1 - 2017/11/7
N2 - 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.
AB - 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.
KW - Journal Article
U2 - 10.1093/eurheartj/ehx437
DO - 10.1093/eurheartj/ehx437
M3 - Article
C2 - 29020300
VL - 38
SP - 3160
EP - 3172
JO - European Heart Journal
JF - European Heart Journal
SN - 0195-668X
IS - 42
ER -