Key result
Polymer-free DES marginally reduces all-cause mortality by ~8% vs polymer-coated DES.
Why the study?
This systematic review and meta-analysis aimed to compare the clinical outcomes of polymer-free versus polymer-coated drug-eluting stents in patients with coronary artery disease.
Does polymer-free drug-eluting stents reduce mortality and cardiovascular events in patients with coronary artery disease compared to polymer-coated drug-eluting stents?
Meta-Analysis (n=28,555)
Yes
Does polymer-free drug-eluting stents reduce mortality and cardiovascular events in patients with coronary artery disease compared to polymer-coated drug-eluting stents?
Effect estimate: RR 0.92 (95% CI 0.85-1.00)
p-value: p=0.05
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.
Offers no compelling reason to prefer polymer-free stents; extends meta-analytic data but leaves the mortality signal inconclusive.
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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Khatri et al. (2023) conducted a meta-analysis in Coronary Artery Disease (n=28,555). Polymer-free drug-eluting stents (PF-DES) vs. Polymer-coated drug-eluting stents (PC-DES) was evaluated on All-cause mortality (RR 0.92, 95% CI 0.85-1.00, p=0.05). 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.
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