Clinical Outcomes of Polymer-Free Versus Polymer-Coated Drug-Eluting Stents in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis

Abstract

Drug-eluting stents have transformed the treatment of coronary artery disease (CAD), and there are two types: polymer-free and polymer-coated stents. Polymer-free stents have a coating that is quickly absorbed by the body, whereas polymer-coated stents have a coating that remains on the stent surface. This meta-analysis and systematic review aimed to compare the clinical outcomes of these two stent types in patients with coronary artery disease. The literature and abstracts from significant databases were reviewed to compare polymer-free drug-eluting stents (PF-DES) and polymer-coated drug-eluting stents (PC-DES) for the treatment of coronary artery disease (CAD). The primary efficacy endpoints of the study were all-cause mortality and deaths from cardiovascular and non-cardiovascular causes. Among the secondary outcomes were incidences of myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), stent thrombosis, stroke, and major adverse cardiovascular events (MACEs). In terms of the primary outcomes, the combined analysis revealed a marginally lower risk of all-cause mortality (relative risk, RR (95% CI) = 0.92 (0.85, 1.00), p = 0.05, I 2 = 0%) with the use of PF-DES versus PC-DES. Nonetheless, there was no significant difference in cardiovascular mortality (RR (95% CI) = 0.97 (0.87, 1.08)) or non-cardiovascular mortality (RR (95% CI) = 0.87 (0.69, 1.10), p = 0.25, I 2 = 9%) between the groups. Furthermore, univariate meta-regression revealed that male gender and prior myocardial infarction were independently associated with an increased risk of all-cause mortality and cardiovascular disease. According to the current meta-analysis, no statistically significant differences existed in PF-DES and PC-DES outcomes. More extensive research is needed to investigate these findings further and establish their validity.

Cardio-Oncology: Managing Cardiovascular Complications of Cancer Therapies

“…Identifying cardiovascular difficulties during initial cancer therapies has led to the development of the field of cardio-oncology, which highlights the significance of a multidisciplinary strategy to enhance the cardiovascular well-being of cancer patients throughout their cancer treatment process [8]. This historical story provides a basis for comprehending the current endeavors to strike a balance between the effectiveness of cancer treatments and the maintenance of cardiovascular well-being as we persist in navigating the intricate realm of cancer and cardiovascular disorders [9].…”

“…The study of cardiovascular problems in cancer patients is a rapidly developing area of research that has gained significant interest due to the expanding number of cancer survivors and the changing landscape of cancer treatments [10]. This section explores the frequency of cardiovascular events in individuals who have survived cancer and the identification of populations at high risk [9]. It provides valuable insights into the intricate relationship between cancer and cardiovascular well-being.…”

“…Incorporating cardio-oncology into the broader context of cancer treatment acknowledges the comprehensive requirements of patients, including their physical, emotional, and social aspects. Cardio-oncology is crucial beyond conventional medical bounds, recognizing the complex relationship between cancer and cardiovascular well-being [9]. This field spans various aspects, including prevention, early detection, and intervention, providing a comprehensive strategy to address the growing cardiovascular problems in cancer patients.…”

Insulin Resistance and Coronary Artery Disease: Untangling the Web of Endocrine-Cardiac Connections

“…Adipose tissue develops resistance to the anti-lipolytic effects of insulin, resulting in an elevated release of free fatty acids (FFAs) into the bloodstream. Increased levels of circulating FFAs contribute to the accumulation of fat in non-adipose tissues, such as the liver and skeletal muscle, which worsens insulin resistance [8]. Lipid buildup in non-adipose tissues leads to the onset of lipotoxicity, characterized by the harmful impact of excessive lipids on cellular activity.…”

“…Lipotoxicity is closely associated with cellular malfunction, such as endoplasmic reticulum (ER) stress, mitochondrial failure, and apoptosis. Lipotoxicity impairs insulin signaling and plays a role in developing atherosclerosis, a critical factor in the connection between insulin resistance and CAD [8]. The pro-inflammatory and pro-atherogenic actions of lipids contribute to the development and progression of vascular disease.…”