A comparison of the main outcomes from BP-BES and DP-DES at five years of follow-up: A systematic review and meta-analysis

Abstract

Biodegradable polymer biolimus-eluting stents (BP-BES) are third-generation drug-eluting stents (DES) composed of biodegradable polymers that may improve prognosis after percutaneous coronary intervention (PCI). After five years of follow-up, BP-BES showed conflicting results compared to durable polymer drug-eluting stents (DP-DES). We performed a meta-analysis of the outcomes of studies on BP-BES and DP-DES after percutaneous coronary intervention (PCI) at five years of follow-up. Eligible studies were retrieved from PubMed, Embase and the Cochrane Library and reported the results of all-cause mortality, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR) and stent thrombosis (ST) at five years of follow-up. Five studies of a total of 4687 patients were included in the meta-analysis. At five years of follow-up, BP-BES was associated with lower rates of major adverse cardiac events (MACE) (OR = 0.83, 95%CI = [0.71, 0.97]), TLR (OR = 0.77, 95%CI = [0.62, 0.96]) and ST (OR = 0.60, 95%CI = [0.43 to 0.84]), whereas no significant differences in mortality, MI, or TVR rates were detected. Our results demonstrated that at five years of follow-up, BP-BES can significantly reduce the risk of MACE, TLR and ST, which indicate that safety and efficacy were increased after PCI.

Intervenção Coronariana Percutânea em Lesões não Protegidas de Tronco

“…24 O uso de stents farmacológicos de nova geração está associado à menor frequência de complicações pós-procedimento, incluindo a trombose do stent. 25 O primeiro caso sobre tratamento de lesão de tronco não protegida por intervenção percutânea descrito no Brasil foi o tratamento de um paciente com angina estável e sem contraindicação para cirurgia, no qual se optou por intervenção percutânea realizada com stent farmacológico de primeira geração e com bons resultados a curto prazo. 26 Outros autores latino-americanos descrevem bons resultados em relatos de casos ou estudos com amostras pequenas de pacientes com escore SYNTAX de baixo ou médio risco.…”

High Bleeding Risk Patients Treated with Very Thin-Strut Biodegradable Polymer or Thin-Strut Durable Polymer Drug-Eluting Stents in the BIO-RESORT Trial

“…While the absence of durable polymers in BP-DES may reduce inflammation and promote arterial healing, meta-analyses thus far showed no unequivocal benefit in clinical outcome for broad patient populations treated with BP-DES over DP-DES [ 5 – 8 ]. Our present study adds to the current knowledge that in HBR patients, who have substantially higher event rates than non-HBR patients, there is also no short-term benefit of BP-DES.…”

“…There is no preference for newer-generation BP-DES over DP-DES, as both DES groups have shown to improve clinical outcome as compared to first-generation DES and bare metal stents. Despite the theoretical advantage of BP-DES, meta-analyses of clinical trials showed no unequivocal benefit of BP-DES over contemporary DP-DES [ 5 – 8 ], but there might still be an advantage for BP-DES in high-risk subgroups. Patients who are at high bleeding risk (HBR) may represent such a patient population.…”

Drug-Eluting Stents: Technical and Clinical Progress

“…Therefore, this demonstrates that stent thrombosis is multifactorial and could occur due to every stent component—polymer biocompatibility, strut thickness and design, scaffold material and manufacturing process, as well as antiproliferative drug choice [ 16 ]. Similar situations were observed in the BMS, where further development of materials and design improved procedural outcomes.…”