What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Coronary Artery Disease (n=28555). Intervention: Polymer-free drug-eluting stents (PF-DES) vs. Polymer-coated drug-eluting stents (PC-DES). Primary outcome: All-cause mortality (RR 0.92, 95% CI 0.85-1.00, p=0.05).

April 27, 2023Open Access

Clinical Outcomes of Polymer-Free Versus Polymer-Coated Drug-Eluting Stents in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis

Key Result

Polymer-free drug-eluting stents marginally reduced the risk of all-cause mortality (RR 0.92) compared to polymer-coated drug-eluting stents in patients with coronary artery disease.

Study Design

Type

Meta-Analysis (n=28,555)

Multicenter

Yes

Structured PICO

Does polymer-free drug-eluting stents reduce mortality and cardiovascular events in patients with coronary artery disease compared to polymer-coated drug-eluting stents?

Population

28,555 patients with coronary artery disease (CAD) pooled from 23 studies (20 RCTs and 3 observational studies).

Intervention

Polymer-free drug-eluting stents (PF-DES) with dual antiplatelet therapy (DAPT) for at least six months.

Comparator

Polymer-coated drug-eluting stents (PC-DES), including permanent-polymer (PP) DES and bioresorbable polymer (BP) DES, with dual antiplatelet therapy (DAPT) for at least six months.

Outcome

All-cause mortality, cardiovascular mortality, and non-cardiovascular mortality.hard clinical

In patients with coronary artery disease, polymer-free drug-eluting stents showed a marginally lower risk of all-cause mortality compared to polymer-coated stents, but no significant differences in cardiovascular mortality, myocardial infarction, or MACE.

Main Result

Effect estimate: RR 0.92 (95% CI 0.85-1.00)

p-value: p=0.05

Limitations

Combination of multiple trials with differences in baseline risk profiles of the participants
Various stent comparators in the comparison group, including older and newer generation PP-DES and BP-DES
Analysis included fewer, more extensive trials, which may have resulted in insignificant secondary outcomes due to their low occurrence rate
Follow-up duration varied widely among studies

Abstract

Drug-eluting stents have transformed the treatment of coronary artery disease (CAD), and there are two types: polymer-free and polymer-coated stents. Polymer-free stents have a coating that is quickly absorbed by the body, whereas polymer-coated stents have a coating that remains on the stent surface. This meta-analysis and systematic review aimed to compare the clinical outcomes of these two stent types in patients with coronary artery disease. The literature and abstracts from significant databases were reviewed to compare polymer-free drug-eluting stents (PF-DES) and polymer-coated drug-eluting stents (PC-DES) for the treatment of coronary artery disease (CAD). The primary efficacy endpoints of the study were all-cause mortality and deaths from cardiovascular and non-cardiovascular causes. Among the secondary outcomes were incidences of myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), stent thrombosis, stroke, and major adverse cardiovascular events (MACEs). In terms of the primary outcomes, the combined analysis revealed a marginally lower risk of all-cause mortality (relative risk, RR (95% CI) = 0.92 (0.85, 1.00), p = 0.05, I2 = 0%) with the use of PF-DES versus PC-DES. Nonetheless, there was no significant difference in cardiovascular mortality (RR (95% CI) = 0.97 (0.87, 1.08)) or non-cardiovascular mortality (RR (95% CI) = 0.87 (0.69, 1.10), p = 0.25, I2 = 9%) between the groups. Furthermore, univariate meta-regression revealed that male gender and prior myocardial infarction were independently associated with an increased risk of all-cause mortality and cardiovascular disease. According to the current meta-analysis, no statistically significant differences existed in PF-DES and PC-DES outcomes. More extensive research is needed to investigate these findings further and establish their validity.

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