Key result
Titanium-nitride-oxide-coated stents resulted in similar 5-year MACE rates compared with drug-eluting stents in ACS patients (12.6% vs 16.2%; HR 0.82, 95% CI 0.67-1.00, P=0.051).
Why the study?
In ACS, vascular healing after DES implantation can be delayed, whereas TiNOS demonstrates faster strut coverage without excessive intimal hyperplasia, prompting comparison of their 5-year outcomes.
Do titanium-nitride-oxide-coated stents reduce major adverse cardiac events at 5 years compared to drug-eluting stents in patients with acute coronary syndromes?
Meta-Analysis (n=2,743)
Randomized
Yes
Do titanium-nitride-oxide-coated stents reduce major adverse cardiac events at 5 years compared to drug-eluting stents in patients with acute coronary syndromes?
Hazard Ratio: 0.82 (95% CI 0.67–1)
Absolute Event Rate: 12.6% vs 16.2%
p-value: p=0.051
In patients with acute coronary syndromes, titanium-nitride-oxide-coated stents showed similar rates of MACE compared to drug-eluting stents, but were associated with significantly lower rates of cardiac death, myocardial infarction, and stent thrombosis at 5 years.
TiNOS offers similar MACE but lower cardiac death, MI, and thrombosis versus DES in ACS at 5 years; extends RCT evidence for coated-stent safety.
BACKGROUND AND AIMS: In acute coronary syndromes (ACS), vascular healing at the site of implantation of drug-eluting stents (DES) can be delayed. Titanium-nitride-oxide-coated stents (TiNOS) demonstrate faster strut coverage without the excessive intimal hyperplasia observed with bare metal stents. The 5-year outcomes of patients presenting with ACS, randomized to receive either TiNOS or DES, were compared. METHODS: A systematic review and individual participant data meta-analysis of trials comparing TiNOS with DES for the treatment of ACS was conducted (PROSPERO: CRD42024514342). The primary endpoint was major adverse cardiac events (MACE) at 5 years, a composite of cardiac death (CD), myocardial infarction (MI), and ischaemia-driven target lesion revascularization (TLR). Pre-specified secondary endpoints included CD, MI, TLR, and stent thrombosis. Data were pooled using a mixed-effects Cox regression model with random slope and stratified baseline hazards. RESULTS: Patient-level data (n = 2743) were obtained from three randomized controlled trials (TiNOS: n = 1620 vs. DES: n = 1123). After a median follow-up of 4.93 years, there was no significant difference in the primary endpoint between TiNOS and DES (12.6% vs. 16.2%; hazard ratio [HR] .82, 95% confidence interval [CI] .67-1.00, P = .051), mainly due to a similar rate of TLR (8.0% vs. 8.1%; HR 1.05, 95% CI .80-1.38, P = .733). However, TiNOS was associated with significantly lower rates of CD (1.5% vs. 3.7%; HR .46, 95% CI .26-.81, P = .007), MI (5.2% vs. 9.6%; HR .56, 95% CI .42-.75, P < .001), and stent thrombosis (1.1% vs. 3.8%; HR .30, 95% CI .17-.53, P < .001). CONCLUSIONS: In ACS patients, TiNOS was associated with similar rates of MACE and TLR as compared with DES but significantly lower rates of CD, MI, and stent thrombosis.
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Mahendiran et al. (2025) conducted a meta-analysis in Acute coronary syndromes (ACS) (n=2,743). Titanium-nitride-oxide-coated stents (TiNOS) vs. Drug-eluting stents (DES) was evaluated on Major adverse cardiac events (MACE) at 5 years (composite of cardiac death, myocardial infarction, and ischaemia-driven target lesion revascularization) (HR 0.82, 95% CI 0.67-1.00, p=0.051). Titanium-nitride-oxide-coated stents resulted in similar 5-year MACE rates compared with drug-eluting stents in ACS patients (12.6% vs 16.2%; HR 0.82, 95% CI 0.67-1.00, P=0.051).
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