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Newer-Generation Ultrathin Strut Drug-Eluting Stents Versus Older Second-Generation Thicker Strut Drug-Eluting Stents for Coronary Artery Disease: Meta-Analysis of Randomized Trials

Circulation (New York, N.Y.), 2018-11, Vol.138 (20), p.2216-2226 [Peer Reviewed Journal]

2018 by the American College of Cardiology Foundation and the American Heart Association, Inc. ;ISSN: 0009-7322 ;EISSN: 1524-4539 ;DOI: 10.1161/CIRCULATIONAHA.118.034456

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  • Title:
    Newer-Generation Ultrathin Strut Drug-Eluting Stents Versus Older Second-Generation Thicker Strut Drug-Eluting Stents for Coronary Artery Disease: Meta-Analysis of Randomized Trials
  • Author: Bangalore, Sripal ; Toklu, Bora ; Patel, Neil ; Feit, Frederick ; Stone, Gregg W
  • Is Part Of: Circulation (New York, N.Y.), 2018-11, Vol.138 (20), p.2216-2226
  • Description: BACKGROUND:Contemporary second-generation drug-eluting stents (DES) have superior efficacy and safety in comparison with early-generation stents in patients undergoing percutaneous coronary intervention, in part, related to their thinner struts. Whether newer-generation ultrathin DES further improve clinical outcomes in comparison with older second-generation thicker strut DES is unknown. METHODS:We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for randomized clinical trials that compared newer-generation ultrathin strut DES (defined as strut thickness <70 µm) versus thicker strut second-generation DES and reported clinical outcomes. The primary outcome was target lesion failure (composite of cardiovascular death, target vessel myocardial infarction or ischemia-driven target lesion revascularization) evaluated at 1-year follow-up. Tests for subgroup effects based on the ultrathin strut DES type and the comparator DES type were performed by using meta-regression analysis. RESULTS:We identified 10 trials that randomly assigned 11 658 patients and evaluated 3 newer-generation ultrathin strut DESOrsiro stent (60 μm), MiStent (64 μm), and BioMime (65 µm). In comparison with thicker strut second-generation DES, newer-generation ultrathin strut DES were associated with a 16% reduction in target lesion failure (relative risk, 0.84; 95% CI, 0.72–0.99) driven by less myocardial infarction (relative risk, 0.80; 95% CI, 0.65–0.99). Ultrathin strut DES were also associated with qualitatively lower rates of any stent thrombosis (relative risk, 0.72; 95% CI, 0.51–1.01). Tests for subgroup effects based on the ultrathin strut DES type (P=0.58) and the comparator DES type (P=0.98) were not significant, suggesting consistent outcomes across the 3 ultrathin strut DES and with the different DES comparators. CONCLUSIONS:In patients undergoing percutaneous coronary intervention, newer-generation ultrathin strut DES further improve 1-year clinical outcomes in comparison with contemporary thicker strut second-generation DES.
  • Publisher: by the American College of Cardiology Foundation and the American Heart Association, Inc
  • Language: English
  • Identifier: ISSN: 0009-7322
    EISSN: 1524-4539
    DOI: 10.1161/CIRCULATIONAHA.118.034456
  • Source: Geneva Foundation Free Medical Journals at publisher websites
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