Long term outcomes of ultrathin versus standard thickness second-generation drug eluting stents: Meta-analysis of randomized trials.

Abstract

OBJECTIVE:

Identify the effect of ultrathin drug eluting stents on long term outcomes in coronary artery disease.

BACKGROUND:

Although second-generation drug eluting stents (DES) are superior to first-generation DES, persistence of adverse outcomes has led to continued refinement in design. Ultrathin second-generation DES have been shown to improve outcomes at 1-year follow-up. Beyond 1-year their effect remains unknown.

METHODS:

PubMed, Embase and Cochrane Database were searched for randomized controlled trials that compared ultrathin (defined as <70 um) to standard thickness second-generation DES. Studies were chosen according to the PROSPERO protocol (CRD42020185374). Data from randomized controlled trials were pooled using random-effects model (Mantel-Haenszel). The primary outcome was target lesion failure (TLF) at 2 years, a composite of cardiac death, target vessel myocardial infarction, and ischemia-driven target vessel revascularization. Secondary outcomes included TLF at 3 and 5 years, the components of TLF and definite or probable stent thrombosis. Differences in outcomes between groups were presented in Forest plots as risk ratios (RR) with corresponding 95% confidence intervals (CIs) for each trial.

RESULTS:

We identified 18 publications from 10 trials with14,649 patients. At 2-years there was a significant 12% reduction in TLF (RR, 0.88; 95% CI 0.78-0.99; p < 0.05) associated with the use of ultrathin DES. At 3-years, there was a significant 19% reduction in TLF with ultrathin DES (RR, 0.79; 95% CI 0.64-0.98; p < 0.05).

CONCLUSION:

In patients undergoing percutaneous coronary intervention, ultrathin DES improve long term clinical outcomes.

• Authors: Yasin Hussain, Samantha Gaston, Johnathan Kluger, Tayyab Shah, Yiping Yang, Daniela Tirziu, Alexandra Lansky
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 99 Issue 3 Pg. 563-574 (02 2022) ISSN: 1522-726X [Electronic] United States
• PMID: 34236755 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: © 2021 Wiley Periodicals LLC.

Topics

• Coronary Artery Disease (diagnostic imaging, etiology, therapy)
• Drug-Eluting Stents (adverse effects)
• Humans
• Percutaneous Coronary Intervention (adverse effects)
• Prosthesis Design
• Randomized Controlled Trials as Topic
• Risk Factors
• Treatment Outcome