Author + information
- Received January 16, 2015
- Revision received April 2, 2015
- Accepted April 7, 2015
- Published online June 16, 2015.
- Tullio Palmerini, MD∗,
- Umberto Benedetto, MD†,
- Giuseppe Biondi-Zoccai, MD‡,
- Diego Della Riva, MD∗,
- Letizia Bacchi-Reggiani, MStat∗,
- Pieter C. Smits, MD, PhD§,
- Georgios J. Vlachojannis, MD, PhD§,
- Lisette Okkels Jensen, MD‖,
- Evald H. Christiansen, MD, PhD¶,
- Klára Berencsi, MStat‖,
- Marco Valgimigli, MD#,
- Carlotta Orlandi, MD∗,
- Mario Petrou, MD†,
- Claudio Rapezzi, MD∗ and
- Gregg W. Stone, MD∗∗∗ ()
- ∗Unità Operativa di Cardiologia, Policlinico S. Orsola, Bologna, Italy
- †Oxford Heart Center; Oxford University, Oxford, England
- ‡Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- §Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
- ‖Department of Cardiology, Odense University Hospital, Odense, Denmark
- ¶Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- #Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands
- ∗∗Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
- ↵∗Reprint requests and correspondence:
Dr. Gregg W. Stone, Columbia University Medical Center, New York-Presbyterian Hospital, The Cardiovascular Research Foundation, 111 East 59th Street, 11th Floor, New York, New York 10022.
Background Previous meta-analyses have investigated the relative safety and efficacy profiles of different types of drug-eluting stents (DES) and bare-metal stents (BMS); however, most prior trials in these meta-analyses reported follow-up to only 1 year, and as such, the relative long-term safety and efficacy of these devices are unknown. Many recent studies have now reported extended follow-up data.
Objectives This study sought to investigate the long-term safety and efficacy of durable polymer-based DES, bioabsorbable polymer-based biolimus-eluting stents (BES), and BMS by means of network meta-analysis.
Methods Randomized controlled trials comparing DES to each other or to BMS were searched through MEDLINE, EMBASE, and Cochrane databases and proceedings of international meetings. Information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted.
Results Fifty-one trials that included a total of 52,158 randomized patients with follow-up duration ≥3 years were analyzed. At a median follow-up of 3.8 years, cobalt-chromium everolimus-eluting stents (EES) were associated with lower rates of mortality, definite stent thrombosis (ST), and myocardial infarction than BMS, paclitaxel-eluting stents (PES), and sirolimus-eluting stents (SES) and less ST than BES. Phosphorylcholine-based zotarolimus-eluting stents had lower rates of definite ST than SES and lower rates of myocardial infarction than BMS and PES. The late rates of target-vessel revascularization were reduced with all DES compared with BMS, with cobalt-chromium EES, platinum chromium-EES, SES, and BES also having lower target-vessel revascularization rates than PES.
Conclusions After a median follow-up of 3.8 years, all DES demonstrated superior efficacy compared with BMS. Among DES, second-generation devices have substantially improved long-term safety and efficacy outcomes compared with first-generation devices.
Dr. Palmerini has received speaker fees from Abbott Vascular. Dr. Biondi-Zoccai has lectured, consulted, and served on advisory boards for Bayer; has consulted for DirectFLow Medical, SICI-GISE, Novartis, and Abbott Vascular; has lectured for Abbott Vascular, AstraZeneca, WebMD, and St. Jude Medical; and has consulted and lectured for Boston Scientific, Cordis, and Medtronic. Dr. Smits has received speaker fees from Abbott Vascular; and institutional research grants from Abbott Vascular, Terumo, and St. Jude Medical. Dr. Vlachojannis has received speaker fees from Abbott Vascular. Dr. Jensen has received research grants from Terumo, St. Jude Medical, Biosensors, and Biotronik; and honoraria from Abbott Vascular, AstraZeneca, St. Jude Medical, Biotronik, and Amgen. Dr. Valgimigli has received personal fees and nonfinancial support from The Medicines Company, AstraZeneca, and Terumo; and personal fees from Abbott Vascular outside the scope of the submitted work. Dr. Stone has been a consultant to Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 16, 2015.
- Revision received April 2, 2015.
- Accepted April 7, 2015.
- American College of Cardiology Foundation