Key result
Drug-eluting stents showed no significant difference in in-stent thrombosis (OR 0.79; 95% CI 0.58-1.07), bleeding, or in-hospital mortality compared to bare metal stents in cancer patients.
Why the study?
Cancer patients undergoing PCI for CAD have poor prognoses and increased risks of adverse outcomes, but it is unclear whether these outcomes are related to the stent type utilized.
Do drug-eluting stents reduce in-stent thrombosis, bleeding, or mortality compared to bare metal stents in cancer patients undergoing percutaneous coronary intervention?
Meta-Analysis (n=54,414)
Do drug-eluting stents reduce in-stent thrombosis, bleeding, or mortality compared to bare metal stents in cancer patients undergoing percutaneous coronary intervention?
In cancer patients undergoing PCI, the use of drug-eluting stents compared to bare metal stents does not significantly alter the risk of in-stent thrombosis, bleeding, or in-hospital mortality.
No difference supports comparable short-term safety of DES and BMS in cancer PCI; leaves open randomized trials for efficacy.
Background. Studies have demonstrated poor prognosis in cancer patients who undergo percutaneous coronary intervention (PCI) for coronary artery disease (CAD). Cancer patients receiving PCI are at increased risk of in-stent thrombosis, bleeding, hospital readmissions, and cardiovascular and noncardiovascular mortality when compared to patients without cancer. It is unclear if the poor outcomes in cancer patients are related to the stent type utilized for PCI. This meta-analysis attempts to identify differences in efficacy and safety outcomes when comparing drug-eluting stents (DESs) with bare metal stents (BMSs) in cancer patients. Methods. This meta-analysis is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Medline, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Risk of bias was assessed using the Modified Newcastle-Ottawa scale and Cochrane risk of bias tool. The primary outcomes of interest were in-stent thrombosis, bleeding, and mortality. Results. Four studies comprising of 54,414 patients met the inclusion criteria. There was no difference in in-stent thrombosis (odds ratio (OR): 0.79; 95% confidence interval (CI): 0.58–1.07), bleeding events (OR: 1.38; 95% CI: 0.77–2.49), or in-hospital mortality (OR: 1.92; 95% CI: 0.83–4.43) when comparing cancer patients who underwent PCI with DES vs BMS. Conclusions. This meta-analysis demonstrates no difference in mortality, bleeding, or in-stent thrombosis between revascularization with BMS vs DES in patients with cancer and CAD. Cancer patients included in this meta-analysis experienced higher rates of mortality, bleeding, and in-stent thrombosis after PCI compared to all-comers described in the literature.
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Siddiqui et al. (2024) conducted a meta-analysis in Cancer and coronary artery disease requiring percutaneous coronary intervention (n=54,414). Drug-eluting stents vs. Bare metal stents was evaluated on in-stent thrombosis, bleeding, and mortality (OR 0.79, 95% CI 0.58-1.07). Drug-eluting stents showed no significant difference in in-stent thrombosis (OR 0.79; 95% CI 0.58-1.07), bleeding, or in-hospital mortality compared to bare metal stents in cancer patients.
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