Meta-analysis of Trials Comparing Drug-eluting Stents with Bare Metal Stents: Safety and Efficacy
Hussein Rayatzadeh
Department of Epidemiology, AJA University of Medical Sciences, Tehran, Iran and Cardiovascular Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Ali Reza Khoshdel *
Department of Epidemiology, AJA University of Medical Sciences, Tehran, Iran.
Sam Chitsaz
Cardiovascular Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Ali Pasha Meysamie
Cardiovascular Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Jamshid Bagheri
Cardiovascular Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
*Author to whom correspondence should be addressed.
Abstract
Background: Effects of drug-eluting stents (DESs) on clinical outcomes as well as stent thrombosis are still under debate.
Methods: Our meta-analysis included 26 randomized trials comparing DESs with bare metal stents (BMSs). The endpoints analyzed were all-cause mortality, cardiac death, myocardial infarction (MI), target lesion (TLR) and target vessel (TVR) revascularization, restenosis, and stent thrombosis.
Results: In-stent (Risk Ratio = 0.23 [95% confidence interval: 0.17 - 0.32]) and in-segment restenosis (RR = 0.31 [0.24 - 0.40]) significantly reduced in patients with DESs compared with BMSs. Nonetheless, the all-cause mortality (RR = 0.98 [0.79 - 1.21]) and cardiac death (RR = 0.93 [0.71 - 1.21]) were not significantly different for patients receiving DESs compared with BMSs. DESs versus BMSs resulted in a significant decrease in MI (RR = 0.79 [0.67 - 0.93]), TLR (RR = 0.33 [0.29 - 0.38]), and TVR (RR = 0.47 [0.42 - 0.52]). Stent thrombosis incidence that did not differ in DESs versus BMSs until the first year after implantation, showed an upward trend in DESs compared with BMSs from then on (RR = 3.09 [1.37 - 6.99]).
Conclusions: The use of DESs versus BMSs led to benefits in angiographic restenosis and clinical outcomes. However, higher incidence of long-term stent thrombosis warrants their cautious usage in patients at high-risk of stent thrombosis.
Keywords: Drug-eluting stent, bare metal stent, safety, efficacy, meta-analysis.