Comparison of biodegradable and durable polymer drug-eluting stents in acute coronary syndrome: a meta-analysis

Haoyong Yuan, Zhongshi Wu, Ting Lu, Tingting Wei, Yifan Zeng, Yalin Liu, Can Huang, Haoyong Yuan, Zhongshi Wu, Ting Lu, Tingting Wei, Yifan Zeng, Yalin Liu, Can Huang

Abstract

Objective: To compare the safety and effectiveness between biodegradable polymer drug-eluting stents (BP-DES) and durable polymer drug-eluting stents (DP-DES) in patients with acute coronary syndrome (ACS).

Design: Meta-analysis of randomised controlled trials (RCTs).

Primary and secondary outcome measures: Major adverse cardiovascular events (MACEs) were considered the primary endpoint. Efficacy endpoints included target vessel revascularisation (TVR) and target lesion revascularisation (TLR). Safety endpoints included all-cause death, cardiac death, target vessel myocardial infarction and stent thrombosis (ST).

Methods: We searched PubMed, Medline, Embase and the Cochrane Controlled Register of Trials for comparative studies of BP-DES and DP-DES in patients with ACS from January 2000 to July 2021. Statistical pooling was performed to estimate incidence using a random-effects model with generic inverse-variance weighting. Risk estimates were computed with 95% CIs.

Results: Eight articles with seven RCTs that compared BP-DES and DP-DES in patients with ACS were identified and included in the qualitative and quantitative analyses. There was no difference in the baseline characteristics, except for the number of smoking patients (OR: 1.13, 95% CI 1.03 to 1.24; p=0.008, I2=29%), which was significantly lower in the BP-DES group. The meta-analysis demonstrated that MACEs, efficacy endpoints and safety endpoints were similar between the groups at 1 year. However, the incidence of total ST was significantly different between the BP-DES and DP-DES groups in the follow-up period (p=0.0001). Further analysis showed a statistically significant difference in MACEs (OR: 0.71, 95% CI 0.57 to 0.88; p=0.002, I2=0 %), TLR (OR: 0.71, 95% CI 0.51 to 1.01; p=0.05, I2=0%), TVR (OR: 0.70, 95% CI 0.52 to 0.94; p=0.002, I2=15%), total ST incidence (OR: 0.59, 95% CI 0.46 to 0.77; p=0.0001, I2=48%) and ST incidence (OR: 0.63, 95% CI 0.47 to 0.85; p=0.002, I2=0%) over 2 years.

Conclusion: This meta-analysis revealed that both stent types demonstrated excellent safety and efficacy profiles at 12 months. However, a slight increase in MACEs, TLR, TVR and ST incidence was observed in the DP-DES group over the 2-year follow-up period, suggesting that BP-DES may be more favourable when treating patients with ACS.

Trial registration number: NCT00389220.

Keywords: Coronary heart disease; Coronary intervention; Myocardial infarction.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Baseline characteristics and stent information of patients with acute coronary syndrome (ACS). BP-DES, biodegradable polymer drug-eluting stents; DP-DES, durable polymer drug-eluting stents.
Figure 2
Figure 2
Baseline characteristics and stent information of patients with acute coronary syndrome (ACS). BP-DES, biodegradable polymer drug-eluting stents; DP-DES, durable polymer drug-eluting stents; LVEF, left ventricular ejection fraction.
Figure 3
Figure 3
Baseline characteristics and stent information of patients with acute coronary syndrome (ACS). BP-DES, biodegradable polymer drug-eluting stents; DP-DES, durable polymer drug-eluting stents
Figure 4
Figure 4
Primary endpoint: major adverse cardiac events (MACEs). BP-DES, biodegradable polymer drug-eluting stents; DP-DES, durable polymer drug-eluting stents.
Figure 5
Figure 5
Target vessel revascularisation (TVR). BP-DES, biodegradable polymer drug-eluting stents; DP-DES, durable polymer drug-eluting stents.
Figure 6
Figure 6
Target lesion revascularisation (TLR). BP-DES, biodegradable polymer drug-eluting stents; DP-DES, durable polymer drug-eluting stents.
Figure 7
Figure 7
All-cause death. BP-DES, biodegradable polymer drug-eluting stents; DP-DES, durable polymer drug-eluting stents.
Figure 8
Figure 8
Cardiac-related death. BP-DES, biodegradable polymer drug-eluting stents; DP-DES, durable polymer drug-eluting stents.
Figure 9
Figure 9
Target vessel myocardial infarction (MI). BP-DES, biodegradable polymer drug-eluting stents; DP-DES, durable polymer drug-eluting stents.
Figure 10
Figure 10
Stent thrombosis. BP-DES, biodegradable polymer drug-eluting stents; DP-DES, durable polymer drug-eluting stents.

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