Key result
Second-generation DES cuts major cardiovascular events ~32% vs first-generation stents in chronic total occlusion.
Why the study?
Evidence was limited regarding whether second-generation drug-eluting stents are clinically superior to first-generation stents in patients undergoing PCI for chronic total occlusion lesions.
Do second-generation drug-eluting stents reduce major adverse cardiac events compared to first-generation drug-eluting stents in patients with chronic total occlusion lesions undergoing percutaneous coronary intervention?
Meta-Analysis (n=4,583)
Do second-generation drug-eluting stents reduce major adverse cardiac events compared to first-generation drug-eluting stents in patients with chronic total occlusion lesions undergoing percutaneous coronary intervention?
Second-generation drug-eluting stents significantly reduce MACE, target vessel revascularization, and myocardial infarction compared to first-generation stents in patients undergoing PCI for chronic total occlusion.
Answers are grounded in this paper and cite their sources.
Supports preferring second-generation drug-eluting stents in chronic total occlusion PCI; extends prior comparisons to this high-risk subset.
Background and Objectives: The second-generation drug-eluting stents have been used to treat chronic total occlusion lesion. However, there is limited evidence of the clinical outcomes that whether the second-generation drug-eluting stents is superior to first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The study aimed to compare the differences in clinical outcomes between the two generations drug-eluting stents in patients with those by a meta-analysis. Methods: PubMed, Embase, the Cochrane library and Web of science databases were systemically searched before March, 2021. Randomized controlled trials and observational studies were included to compare the second-generation drug-eluting stents with the first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The clinical outcomes were major adverse cardiac events (MACE), target vessel revascularization, myocardial infarction, all-cause death. Fixed effects models were used to calculate the odds ratio (OR) and 95% confidence interval (CI) of each clinical outcome. Sensitivity analysis was performed to detect potential sources of heterogeneity. Subgroup analyses were used to assess the differential effects. Results: The meta-analysis included eight studies involving 4,583 patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. Pooled analysis showed that the incidence of MACE (OR = 0.68, 95%CI 0.54–0.85, P = 0.0008), target vessel revascularization (OR = 0.70, 95%CI 0.54–0.91, P = 0.007), and myocardial infarction (OR = 0.58, 95%CI 0.37–0.93, P = 0.02) were lower in the second-generation drug-eluting stents compared with the first-generation ones. However, there was not difference in all-cause deaths between two drug-eluting stents (OR = 0.67, 95%CI 0.45–1.01, P = 0.05). Conclusions: The second-generation drug-eluting stents are associated with lower MACE, target vessel revascularization, and myocardial infarction compared with the first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The results of this study can provide a reference for the selection of stents in patients with chronic total occlusion lesion. Further randomized controlled trials are needed to verify that the second-generation drug-eluting stents is superior to the first-generation ones in patients with chronic total occlusion (Registered by PROSPERO, CRD42020158406).
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Qiao et al. (2021) conducted a meta-analysis in Chronic Total Occlusion (CTO) (n=4,583). Second-generation drug-eluting stents vs. First-generation drug-eluting stents was evaluated on Major adverse cardiac events (MACE) (OR 0.68, 95% CI 0.54-0.85, p=0.0008). Second-generation drug-eluting stents reduced the incidence of major adverse cardiac events compared with first-generation stents in patients with chronic total occlusion.
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