Clinical outcome of drug‐eluting versus bare‐metal stents in patients with calcified coronary lesions: a meta‐analysis

BACKGROUND: The relative safety and efficacy of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients with calcified coronary lesions is still debated. AIMS: To evaluate clinical outcome of DES versus BMS in patients with calcified coronary lesions using a meta-analysis of the current literature. METHODS: We performed a systematic literature search using Medline, Embase, Cochrane and several other databases. Randomised controlled trials, prospective and retrospective cohort studies with a mean follow-up period >6 months were included. Primary efficacy was target lesions revascularisation (TLR) and primary end-point for safety was stent thrombosis. Secondary end-points were cardiac death and recurrent myocardial infarction (MI). RESULTS: Five trials were included in the meta-analysis, including 2440 patients (1230 in the DES group, 1210 in the BMS group). TLR was significantly lower in patients treated with DES as compared with patients treated with BMS (8.5% vs 16.0%; odds ratio (OR) = 0.50; 95% confidence interval (CI) 0.38-0.65; P < 0.00001). There were no significant differences in the incidence of stent thrombosis (0.9% vs 0.3%; OR = 2.01; 95% CI 0.34-11.88; P = 0.44), cardiac death (3.3% vs 4.2%; OR = 0.81; 95% CI 0.50-1.30; P = 0.38) and recurrent MI (5.0% vs 5.2%; OR = 0.99; 95% CI, 0.66-1.49; P = 0.97) between the two groups. Subgroup analysis by the sample size and follow-up duration showed that the associations were similar between DES versus BMS. CONCLUSIONS: DES significantly reduces TLR rates as compared with BMS in patients with calcified coronary lesions, with non-significant differences in terms of stent thrombosis, cardiac death and MI.