Individual Patient Data Meta-analysis of Drug-eluting Versus Bare-metal Stents for Percutaneous Coronary Intervention in Chronic Versus Acute Coronary Syndromes

New-generation drug-eluting stents (DES) strongly reduce restenosis and repeat revascularization compared with bare-metal stents (BMS) for percutaneous coronary intervention. There is residual uncertainty as to whether other prognostically relevant outcomes are affected by DES versus BMS concerning...

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Published in:The American journal of cardiology 2022-11, Vol.182, p.8-16
Main Authors: Piccolo, Raffaele, Bonaa, Kaare H., Efthimiou, Orestis, Varenne, Olivier, Baldo, Andrea, Urban, Philip, Kaiser, Christoph, de Belder, Adam, Lemos, Pedro A., Wilsgaard, Tom, Reifart, Jörg, Ribeiro, Expedito E., Serruys, Patrick WJC, Byrne, Robert A., de la Torre Hernandez, Jose M., Esposito, Giovanni, Wijns, William, Jüni, Peter, Windecker, Stephan, Valgimigli, Marco
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - complications
Acute coronary syndromes
Angioplasty
Bias
Cardiovascular disease
Clinical trials
Collaboration
Confidence intervals
Coronary vessels
Data analysis
Death
Drug delivery
Drug-Eluting Stents - adverse effects
Heart
Humans
Implants
Meta-analysis
Metals
Mortality
Myocardial infarction
Myocardial Infarction - epidemiology
Myocardial Infarction - etiology
Patients
Percutaneous Coronary Intervention - adverse effects
Prosthesis Design
Restenosis
Risk
Risk Factors
Risk reduction
Stents
Stents - adverse effects
Treatment Outcome
Vein & artery diseases
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Description
Summary:New-generation drug-eluting stents (DES) strongly reduce restenosis and repeat revascularization compared with bare-metal stents (BMS) for percutaneous coronary intervention. There is residual uncertainty as to whether other prognostically relevant outcomes are affected by DES versus BMS concerning initial presentation (chronic coronary syndrome [CCS] vs acute coronary syndrome [ACS]). We performed an individual patient data meta-analysis of randomized trials comparing new-generation DES versus BMS (CRD42017060520). The primary outcome was the composite of cardiac death or myocardial infarction (MI). Outcomes were examined at maximum follow-up and with a 1-year landmark. Risk estimates are expressed as hazard ratio (HR) with 95% confidence interval (CI). A total of 22,319 patients were included across 14 trials; 7,691 patients (34.5%) with CCS and 14,628 patients (65.5%) with ACS. We found evidence that new-generation DES versus BMS consistently reduced the risk of cardiac death or MI in both patients with CCS (HR 0.83, 95% CI 0.70 to 0.98, p
ISSN:0002-9149
1879-1913
1879-1913
DOI:10.1016/j.amjcard.2022.07.035