Author + information
- 1MonashHeart, Monash Health, Melbourne, Victoria, Australia
- 2Monash Health, MonashHeart, Melbourne, Victoria, Australia
- 3MonashHeart, Clayton, Victoria, Australia
- 4Monash University, Melbourne, Victoria, Australia
- 5MonashHeart, Melbourne, Victoria, Australia
- 6MonashHeart, Monash Medical Centre, Clayton, Victoria, Australia
The permanent polymer (PP) used in early generation drug-eluting stents (DES) has been implicated in delayed arterial healing and incomplete strut re-endothelialization, predisposing to late stent thrombosis (ST). Polymer-free DES (PF-DES) were developed to address these concerns. Although previous meta-analyses have shown similar outcomes between PF-DES and PP-DES, these studies were limited by short duration of follow-up and further randomized data are now available.
Electronic databases were searched for randomized trials of PF-DES vs. PP-DES. The primary endpoint was target lesion revascularization (TLR), with secondary endpoints including all-cause mortality, myocardial infarction (MI), ST and target vessel revascularization (TVR). Odds ratio (OR) and 95% confidence intervals (CI) were obtained using Peto modeling.
Of 1,112 studies identified, 11 met inclusion criteria including 6,732 patients. Mean follow up was 31±19mnths and 40% had diabetes mellitus. Of these, 3,728 patients received PF-DES and 3,004 PP-DES. There was no significant difference in the incidence of TLR between PF-DES and PP-DES (OR 0.99, CI 0.85-1.16, p=0.94)(Figure 1). The incidence of all-cause mortality (OR 0.85, CI 0.72-1.00, p=0.06), MI (OR 0.95, CI 0.73-1.25, p=0.72), ST (OR 0.92, CI 0.59-1.44, p=0.73) and TVR (OR 1.07, CI 0.91-1.26, p=0.42) were also similar between groups.
These data show that PF-DES have equivalent clinical outcomes when compared with PP-DES. Further randomized trials are required to ascertain the role of PF-DES in contemporary interventional practice.
CORONARY: Stents: Drug-Eluting