Key result
Titanium-nitride-oxide-coated stents were a non-inferior alternative to drug-eluting stents for major adverse cardiac events in patients with acute coronary syndrome (RR 0.93; 95% CI 0.72-1.20).
Why the study?
Practice guidelines recommend DES as standard of care in PCI for ACS based on comparisons with BMS, without accounting for non-drug-eluting TiNOS.
Do titanium-nitride-oxide-coated stents (TiNOS) reduce device-oriented Major Adverse Cardiac Events compared to drug-eluting stents in patients with acute coronary syndrome?
Meta-Analysis (n=3,218)
Do titanium-nitride-oxide-coated stents (TiNOS) reduce device-oriented Major Adverse Cardiac Events compared to drug-eluting stents in patients with acute coronary syndrome?
TiNOS may serve as a non-inferior and safe alternative to DES in patients with ACS, offering lower risks of recurrent MI and stent thrombosis despite higher target lesion revascularization rates.
Supports TiNOS as non-inferior alternative to DES in ACS; extends safety evidence with lower MI and thrombosis despite higher TLR.
(1) Background: Practice guidelines define drug-eluting stents (DES) as the standard of care in coronary percutaneous coronary intervention (PCI), including in acute coronary syndrome (ACS). This is based on comparisons with bare-metal stents (BMS). However, non-drug-eluting titanium-nitride-oxide-coated stents (TiNOS) have not been taken into account. The objective of this study is to determine whether TiNOS can be used as an alternative to DES in ACS. (2) Methods: A prospective systematic literature review (SLR), conducted according to the PRISMA guidelines, was performed, wherein multiple literature databases from 2018 and 2022 were searched. Prospective, randomised, controlled trials comparing outcomes after PCI with TiNOS vs. DES in any coronary artery disease (CAD) were searched. Clinical outcomes were meta-analytic pooled risk ratios (RR) of device-oriented Major Adverse Cardiac Events (MACE) and their components. The analysis stratified outcomes reported with ACS-only vs. ACS jointly with chronic coronary syndrome (CCS). (3) Results: Five RCTs were eligible, comprising 1855 patients with TiNOS vs. 1363 with DES at a 1-year follow-up. Three enrolled patients presented with ACS only and two with ACS or CCS. The latter accounted for most of the patients. The one-year pooled RRs in those three RCTs were as follows: MACE 0.93 [0.72, 1.20], recurrent myocardial infarction (MI) 0.48 [0.31, 0.73], cardiac death (CD) 0.66 [0.33, 1.31], clinically driven target lesion revascularization (TLR) 1.55 [1.10, 2.19], and stent thrombosis (ST) 0.35 [0.20, 0.64]. Those results were robust to a sensitivity analysis. The evidence certainty was high in MACE and moderate or low in the other endpoints. (4) Conclusions: TiNOS are a non-inferior and safe alternative to DES in patients with ACS.
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Daoud et al. (2022) conducted a meta-analysis in Acute Coronary Syndrome (n=3,218). Titanium-nitride-oxide-coated stents (TiNOS) vs. Drug-eluting stents (DES) was evaluated on Device-oriented Major Adverse Cardiac Events (MACE) (RR 0.93, 95% CI 0.72-1.20). Titanium-nitride-oxide-coated stents were a non-inferior alternative to drug-eluting stents for major adverse cardiac events in patients with acute coronary syndrome (RR 0.93; 95% CI 0.72-1.20).
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