Comparison of biodegradable and durable polymer drug-eluting stents in acute coronary syndrome: a meta-analysis

Abstract

ObjectiveTo compare the safety and effectiveness between biodegradable polymer drug-eluting stents (BP-DES) and durable polymer drug-eluting stents (DP-DES) in patients with acute coronary syndrome (ACS).DesignMeta-analysis of randomised controlled trials (RCTs).Primary and secondary outcome measuresMajor adverse cardiovascular events (MACEs) were considered the primary endpoint. Efficacy endpoints included target vessel revascularisation (TVR) and target lesion revascularisation (TLR). Safety endpoints included all-cause death, cardiac death, target vessel myocardial infarction and stent thrombosis (ST).MethodsWe searched PubMed, Medline, Embase and the Cochrane Controlled Register of Trials for comparative studies of BP-DES and DP-DES in patients with ACS from January 2000 to July 2021. Statistical pooling was performed to estimate incidence using a random-effects model with generic inverse-variance weighting. Risk estimates were computed with 95% CIs.ResultsEight articles with seven RCTs that compared BP-DES and DP-DES in patients with ACS were identified and included in the qualitative and quantitative analyses. There was no difference in the baseline characteristics, except for the number of smoking patients (OR: 1.13, 95% CI 1.03 to 1.24; p=0.008, I2=29%), which was significantly lower in the BP-DES group. The meta-analysis demonstrated that MACEs, efficacy endpoints and safety endpoints were similar between the groups at 1 year. However, the incidence of total ST was significantly different between the BP-DES and DP-DES groups in the follow-up period (p=0.0001). Further analysis showed a statistically significant difference in MACEs (OR: 0.71, 95% CI 0.57 to 0.88; p=0.002, I2=0 %), TLR (OR: 0.71, 95% CI 0.51 to 1.01; p=0.05, I2=0%), TVR (OR: 0.70, 95% CI 0.52 to 0.94; p=0.002, I2=15%), total ST incidence (OR: 0.59, 95% CI 0.46 to 0.77; p=0.0001, I2=48%) and ST incidence (OR: 0.63, 95% CI 0.47 to 0.85; p=0.002, I2=0%) over 2 years.ConclusionThis meta-analysis revealed that both stent types demonstrated excellent safety and efficacy profiles at 12 months. However, a slight increase in MACEs, TLR, TVR and ST incidence was observed in the DP-DES group over the 2-year follow-up period, suggesting that BP-DES may be more favourable when treating patients with ACS.Trial registration numberNCT00389220.

Long‐term outcomes after coronary intervention with biodegradable polymer stents in patients with acute coronary syndromes

“…DES with biodegradable polymers have been shown to improve device‐ and patient‐oriented clinical outcomes up to 5 years of follow‐up compared to BMS and early‐generation polymer‐based DES 20,21 . A meta‐analysis comparing biodegradable polymer DES with durable polymer DES concluded, that biodegradable polymer DES might be more favorable when treating patients with ACS 9,22 …”

“…8 To improve safety of DES and decrease risk of inflammation due to durable polymers, DES with a biodegradable polymer (BP-DES) were designed, and meta-analysis shows that these BP-DES are significantly more effective than bare metal stents (BMS) and safer than first-generation DES. 9,10 Theoretically, BP-DES would decrease risk of inflammation and late stent thrombosis (LST), since it leaves behind a BMS after complete drug elution and polymer degradation. However, long-term follow-up studies are needed to assess the safety of newer stents.…”

Is There an Advantage of Ultrathin-Strut Drug-Eluting Stents over Second- and Third-Generation Drug-Eluting Stents?

“…In most stent trials, there is no evidence of an interaction between patient subgroups and the efficacy of one type of stent compared with another. A biodegradable polymer DES may be more suitable for patients with stent thrombosis myocardial infarction [56]. The BIOSTEMI trial demonstrated the superiority of the ultrathin sirolimus-eluting bioresorbable polymer stent Orsiro over the durable polymer everolimus-eluting XIENCE at one year based on TLF [57].…”

Long non-coding RNA SNHG7 serves as a diagnostic biomarker for acute coronary syndrome and its predictive value for the clinical outcome after percutaneous coronary intervention

“…ACS has a poor prognosis and a high mortality rate among cardiology diseases. Currently, most patients with ACS are treated with percutaneous coronary intervention (PCI) [ 4 ]. The main application of this method is cardiac catheterization technology, which can make the narrowed or occluded coronary artery lumen reopen and improve the quality of the coronary artery [ 5 ].…”