Impact of biodegradable versus durable polymer drug-eluting stents on clinical outcomes in patients with coronary artery disease: a meta-analysis of 15 randomized trials.

Yaojun Zhang; Nailiang Tian; Shengjie Dong; Fei YE; Minghui LI; Christos V Bourantas; Javaid Iqbal; Yoshinobu Onuma; Takashi Muramatsu; Roberto Diletti; Hector M Garcia-garcia; Bo XU; Patrick W Serruys; Shaoliang Chen

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Impact of biodegradable versus durable polymer drug-eluting stents on clinical outcomes in patients with coronary artery disease: a meta-analysis of 15 randomized trials.

Author: Yaojun ZHANG ¹ ; Nailiang TIAN ² ; Shengjie DONG ³ ; Fei YE ² ; Minghui LI ² ; Christos V BOURANTAS ¹ ; Javaid IQBAL ¹ ; Yoshinobu ONUMA ¹ ; Takashi MURAMATSU ¹ ; Roberto DILETTI ¹ ; Hector M GARCIA-GARCIA ¹ ; Bo XU ⁴ ; Patrick W SERRUYS ¹ ; Shaoliang CHEN ⁵
Author Information

1. Thoraxcenter, Erasmus Medical Center, Rotterdam, 3015CE, The Netherlands.
2. Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China.
3. Soochow University, Suzhou, Jiangsu 215021, China.
4. Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases of China, Beijing 100037, China.
5. Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China. Email: chmengx126@gmail.com.
Publication Type:Journal Article
MeSH: Coronary Artery Disease; drug therapy; surgery; Drug-Eluting Stents; Humans; Polymers; administration & dosage; Thrombosis
From: Chinese Medical Journal 2014;127(11):2159-2166
CountryChina
Language:English
Abstract:
BACKGROUNDDrug eluting stents (DESs) made with biodegradable polymer have been developed in an attempt to improve clinical outcomes. However, the impact of biodegradable polymers on clinical events and stent thrombosis (ST) remains controversial.
METHODSWe searched Medline, the Cochrane Library and other internet sources, without language or date restrictions for articles comparing clinical outcomes between biodegradable polymer DES and durable polymer DES. Safety endpoints were ST (definite, definite/probable), mortality, and myocardial infarction (MI). Efficacy endpoints were major adverse cardiac event (MACE) and target lesion revascularization (TLR).
RESULTSWe identified 15 randomized controlled trials (n = 17 068) with a weighted mean follow-up of 20.6 months. There was no statistical difference in the incidence of definite/probable ST between durable polymer- and biodegradable polymer- DES; relative risk (RR) 0.83; 95% confidence interval (CI) 0.62-1.11; P = 0.22. Biodegradable polymer DES had similar rates of definite ST (RR 0.94, 95% CI 0.66-1.33, P = 0.72), mortality (RR 0.94, 95% CI 0.82-1.09, P = 0.43), MI (RR 1.08, 95% CI 0.92-1.26. P = 0.35), MACE (RR 0.99, 95% CI 0.91-1.09, P = 0.85), and TLR (RR, 0.94, 95% CI 0.83-1.06, P = 0.30) compared with durable polymer DES. Based on the stratified analysis of the included trials, the treatment effect on definite ST was different at different follow-up times: ≤ 1 year favoring durable polymer DES and >1 year favoring biodegradable polymer DES.
CONCLUSIONSBiodegradable polymer DES has similar safety and efficacy for treating patients with coronary artery disease compared with durable polymer DES. Further data with longer term follow-up are warranted to confirm the potential benefits of biodegradable polymer DES.