Polymer-free drug-eluting stents showed no significant difference in MACE compared to polymer-coated stents (OR 0.98; 95% CI 0.91-1.08), but had lower all-cause mortality.
Meta-Analysis (n=23,198)
Does polymer-free DES reduce MACE in patients with angina or ACS undergoing PCI compared to polymer-coated DES?
In patients undergoing PCI for angina or ACS, polymer-free DES showed similar MACE and major bleeding compared to polymer-coated DES, but was associated with lower all-cause mortality and higher target lesion revascularization.
Effect estimate: OR 0.98 (95% CI 0.91-1.08)
INTRODUCTION: The relative safety and efficacy of polymer-free (PF) versus polymer-coated (PC) drug-eluting stents (DES) in patients with angina or acute coronary syndrome (ACS) undergoing percutaneous coronary intervention has received limited study. METHOD: Digital databases were queried to identify relevant studies. Major adverse cardiovascular events (MACE) and secondary outcomes were compared using a random effect model to calculate unadjusted odds ratios (OR). RESULTS: A total of 28 studies consisting of 23,198 patients were included in the final analysis. On pooled analysis, there was no significant difference in the odds of MACE (OR 0.98, 95% CI 0.91-1.08) and major bleeding (OR 0.87, 95% CI 0.61-1.24) between patients undergoing PF-DES versus PC-DES. Similarly, the odds of myocardial infarction, stroke, stent thrombosis, cardiovascular mortality and need for target vessel revascularization was similar between the two groups. PF-DES was favored due to significantly lower odds of non-cardiac death (OR 0.78, 95% CI 0.68-89) and all-cause mortality (OR 0.87, 95% CI 0.80-0.95), but had a higher need for target lesion revascularization (OR 1.2, 95% CI 1.02-1.42). A subgroup analysis based on follow up duration, clinical presentation, presence of diabetes and class of eluting drugs mirrored the net estimates for all outcomes with a few exceptions. A sensitivity and meta-regression analysis showed no influence of single-study and duration of antiplatelet therapy on pooled outcomes. CONCLUSION: In patients presenting with angina or ACS, PF-DES might be favored due to lower all-cause mortality and equal risk of ischemic adverse cardiovascular and major bleeding events compared with PC-DES.
Ullah et al. (Sun,) conducted a meta-analysis in Angina or acute coronary syndrome (ACS) (n=23,198). Polymer-free (PF) drug-eluting stents (DES) vs. Polymer-coated (PC) drug-eluting stents (DES) was evaluated on Major adverse cardiovascular events (MACE) (OR 0.98, 95% CI 0.91-1.08). Polymer-free drug-eluting stents showed no significant difference in MACE compared to polymer-coated stents (OR 0.98; 95% CI 0.91-1.08), but had lower all-cause mortality.