ABSTRACT First‐generation drug‐eluting stents (DES) with thick polymers may contribute to local vascular inflammation and late stent thrombosis. Thinner‐strut DES, particularly those with biodegradable polymers and ultrathin struts, aim to reduce this risk by minimizing flow disturbance and vascular injury. Nonetheless, the long‐term safety and efficacy of ultrathin biodegradable polymer sirolimus‐eluting stents (BP‐SES) compared to durable polymer everolimus‐eluting stents (DP‐EES) are still uncertain. Thus, we performed a meta‐analysis with the aim of comparing outcomes of these two stents. Inclusion criteria comprised randomized controlled trials (RCTs) that compared ultrathin/thin BP‐SES and thin DP‐EES in patients undergoing percutaneous coronary interventions (PCI) and had long‐term follow‐up reports of at least 3 years. We excluded cohort studies, case reports, editorials, conference abstracts, and animal studies. Our primary outcomes were target lesion failure (TLF), cardiac death (CD), target‐vessel myocardial infarction (TV‐MI), and clinically indicated target lesion revascularization (CI‐TLR). We systematically searched PubMed, Cochrane CENTRAL, and Scopus. Cochrane's ROB 2.0 tool was used for assessing the quality of all included RCTs. RevMan software (5.4) was used to perform the meta‐analysis. Our analysis included 10 RCTs, totaling 16,216 patients, with 9108 in the BP‐SES group and 7108 in the DP‐EES group. TLF occurred in 905 patients (9.94%) in the BP‐SES group and 821 patients (11.55%) in the DP‐DES group, with no statistically significant differences between the groups (RR = 0.92, 95% CI = 0.85−1.01, p = 0.08). Additionally, there were no significant differences in CD (RR = 1.00, 95% CI = 0.84−1.19, p = 1.00), TV‐MI (RR = 0.91, 95% CI = 0.78−1.05, p = 0.19), and CI‐TLR (RR = 0.88, 95% CI = 0.78−1.01, p = 0.06) between the two groups. BP‐SES and DP‐EES showed comparable long‐term safety and efficacy in most PCI patients and lesion subsets. A significant reduction in TLF with BP‐SES was observed in STEMI, without increased thrombotic risk, while outcomes were consistent across other subgroups. Head‐to‐head analyses confirmed no major long‐term differences between Orsiro BP‐SES and Xience DP‐EES. In practice, either stent can be used with confidence, with BP‐SES favored in settings such as STEMI, where its potential advantages may offer additional clinical benefit.
Abouelenien et al. (Fri,) studied this question.