Clinical Outcomes of Biodegradable Polymer Drug‐Eluting Stents for Percutaneous Coronary Intervention: An Updated Meta‐analysis of Randomized Controlled Trials

Kwong, Joey S.W.; Yu, Cheuk‐Man

doi:10.1002/clc.22285

Cited by 5 publications

(1 citation statement)

References 43 publications

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“…Given the results of a recent meta‐analysis, 2G‐DP‐DES and BP‐DES may provide more favorable clinical outcomes compared to 1G‐DES or bare‐metal stents in AMI patients. No randomized clinical trial, however, was available to compare the efficacy and safety between 2G‐DP‐DES and BP‐DES in this patient subset.…”

Section: Discussionmentioning

confidence: 99%

Two‐Year Safety and Efficacy of Biodegradable Polymer Drug‐Eluting Stent Versus Second‐Generation Durable Polymer Drug‐Eluting Stent in Patients With Acute Myocardial Infarction: Data from the Korea Acute Myocardial Infarction Registry (KAMIR)

Hur

Kim

Won

et al. 2016

Clinical Cardiology

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Background: Despite improved long-term safety of biodegradable polymer (BP) drug-eluting stents (DES) compared to first-generation durable polymer (DP) DES, data on the safety and efficacy of BP-DES compared with second-generation (2G) DP-DES in patients with acute myocardial infarction (AMI) are limited. Hypothesis: To evaluate the safety and efficacy of BP-DES compared with 2G-DP-DES in the higher stent thrombosis (ST) risk setting of AMI. Methods: A total of 3359 AMI patients who received either BP-DES (n = 261) or 2G-DP-DES (n = 3098) were included from the Korea Acute Myocardial Infarction Registry (KAMIR). Differences in baseline clinical and angiographic characteristics were adjusted using a 1:5 propensity score matching analysis (n = 261 for BP-DES and n = 1305 for 2G-DP-DES). The primary outcome was the incidence of major adverse cardiac events (MACE) including all-cause death, recurrent myocardial infarction (re-MI), and target vessel revascularization (TVR). The rate of definite or probable ST was also investigated. Results: In adjusted analysis, there was no significant difference between the 2 groups in baseline clinical and angiographic characteristics; 2-year MACE (10.7% and 9.9% in the BP-DES group and 2G-DP-DES group, respectively, P = 0.679); ST incidence (0.8% vs 0.9%, respectively, P = 1.0), and rates of all-cause death, re-MI, and TVR. By multivariate analysis, old age, diabetes mellitus, renal dysfunction, and left ventricular dysfunction were the independent predictors of MACE after BP-DES or 2G-DP-DES implantation. Conclusions: BP-DES and 2G-DP-DES appear to have comparable 2-year safety and efficacy for the treatment of AMI. However, longer-term follow-up is needed. Introduction First-generation (1G) drug-eluting stents (DES) are associated with remarkable reduction of neointimal proliferation and favorable clinical outcomes, 1 yet raised concerns regarding stent thrombosis (ST), especially at late or very late phases.2 Polymer, a key component of DES platforms, is a risk factor for ST occurrence. In 1G-DES, durable polymer (DP) controls drug release kinetics, while potentially causing local inflammation and hypersensitivity, 3 which fueled the use of more biocompatible DPs (such as fluorocopolymer) or biodegradable polymers (BP) in second-generation (2G) or third-generation DES. 4 A recent network metaanalysis showed a lower incidence of ST with 2G-DP-DES, 5 and in the LEADERS (Limus Eluted From a Durable Versus Erodable Stent Coating) trial, BP-DES yielded a lower 5-year risk of ST relative to 1G-DP-DES. 4 However, it remains undefined how BP-DES and 2G-DP-DES compare in terms of the risk of polymer-related ST. Acute myocardial infarction (AMI) is reported to be associated with risk of ST after stent implantation, 2 and patients with AMI are frequently treated with DES. The purpose of this study, therefore, was to evaluate the safety and efficacy of BP-DES compared with 2G-DP-DES in the higher ST risk setting of AMI.

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Section: Discussionmentioning

confidence: 99%