Author + information
- Received March 15, 2016
- Accepted March 24, 2016
- Published online June 27, 2016.
- Si-Hyuck Kang, MDa,
- In-Ho Chae, MD, PhDa,
- Jin-Joo Park, MD, PhDa,
- Hak Seung Lee, MDb,
- Do-Yoon Kang, MDc,
- Seung-Sik Hwang, MD, PhDd,
- Tae-Jin Youn, MD, PhDa,∗ ( and )
- Hyo-Soo Kim, MD, PhDb
- aDivision of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea
- bDivision of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
- cDepartment of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- dDepartment of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
- ↵∗Reprint requests and correspondence:
Dr. Tae-Jin Youn, Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
Objectives This study sought to perform a systematic review and network meta-analysis to compare the relative safety and efficacy of contemporary DES and BVS.
Background To improve outcomes of patients undergoing percutaneous coronary revascularization, there have been advances in the design of drug-eluting stents (DES), including the development of drug-eluting bioresorbable vascular scaffolds (BVS).
Methods Prospective, randomized, controlled trials comparing bare-metal stents (BMS), paclitaxel-eluting stents (PES), sirolimus-eluting stents (SES), Endeavor zotarolimus-eluting stents (E-ZES), cobalt-chromium (CoCr) everolimus-eluting stents (EES), platinum-chromium (PtCr)-EES, biodegradable polymer (BP)-EES, Resolute zotarolimus-eluting stents (R-ZES), BP biolimus-eluting stents (BP-BES), hybrid sirolimus-eluting stents (H [Orsiro]-SES), polymer-free sirolimus- and probucol-eluting stents, or BVS were searched in online databases. The primary endpoint was definite or probable stent thrombosis at 1 year.
Results A total of 147 trials including 126,526 patients were analyzed in this study. All contemporary DES were superior to BMS and PES in terms of definite or probable stent thrombosis at 1 year. CoCr-EES, PtCr-EES, and H-SES were associated with significantly lower risk than BVS. CoCr-EES and H-SES were superior to SES and BP-BES. The risk of myocardial infarction was significantly lower with H-SES than with BVS. There were no significant differences regarding all-cause or cardiac mortality. Contemporary devices including BVS showed comparably low risks of repeat revascularization.
Conclusions Contemporary DES, including biocompatible DP-DES, BP-DES, and polymer-free DES, showed a low risk of definite or probable stent thrombosis at 1 year. BVS had an increased risk of device thrombosis compared with CoCr-EES, PtCr-EES, and H-SES. Data from extended follow-up are warranted to confirm the long-term safety of contemporary coronary devices.
- bare-metal stent(s)
- bioresorbable vascular scaffolds
- drug-eluting stent(s)
- percutaneous coronary intervention
- stent thrombosis
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Kang and Chae contributed equally to the work.
- Received March 15, 2016.
- Accepted March 24, 2016.
- American College of Cardiology Foundation