Efficacy and Safety of TiNO-Coated Stents versus Drug-Eluting Stents in Acute Coronary Syndrome: Systematic Literature Review and Meta-Analysis

Abstract

(1) Background: Practice guidelines define drug-eluting stents (DES) as the standard of care in coronary percutaneous coronary intervention (PCI), including in acute coronary syndrome (ACS). This is based on comparisons with bare-metal stents (BMS). However, non-drug-eluting titanium-nitride-oxide-coated stents (TiNOS) have not been taken into account. The objective of this study is to determine whether TiNOS can be used as an alternative to DES in ACS. (2) Methods: A prospective systematic literature review (SLR), conducted according to the PRISMA guidelines, was performed, wherein multiple literature databases from 2018 and 2022 were searched. Prospective, randomised, controlled trials comparing outcomes after PCI with TiNOS vs DES in any coronary artery disease (CAD) were searched. Clinical outcomes were meta-analytic pooled risk ratios (RR) of device-oriented Major Adverse Cardiac Events (MACE) and their components. The analysis stratified outcomes reported with ACS-only vs ACS jointly with chronic coronary syndrome (CCS). (3) Results: Five RCTs were eligible, comprising 1855 patients with TiNOS vs 1363 with DES at a 1-year follow-up. Three enrolled patients presented with ACS only and two with ACS or CCS. The latter accounted for most of the patients. The one-year pooled RRs in those three RCTs were as follows: MACE 0.93 [0.72, 1.20], recurrent myocardial infarction (MI) 0.48 [0.31, 0.73], cardiac death (CD) 0.66 [0.33, 1.31], clinically driven target lesion revascularization (TLR) 1.55 [1.10, 2.19], and stent thrombosis (ST) 0.35 [0.20, 0.64]. Those results were robust to a sensitivity analysis. The evidence certainty was high in MACE and moderate or low in the other endpoints. (4) Conclusions: TiNOS are a non-inferior and safe alternative to DES in patients with ACS.

Five-year Efficacy and Safety of TiNO-Coated Stents Versus Drug-Eluting Stents in Acute Coronary Syndrome. A meta-analysis

“…The endpoint definitions were those of the Academic Research Consortium (ARC-2) [13]. The detailed SLR and meta-analytic methods applied with 5-year outcomes were similar to those used with 1-year outcomes and previously published, except for the updates below [2,3]. F.D.…”

“…The 5-year follow-up outcomes meta-analysis was computed in the 2023 versions of the same software packages as used with 1-year follow-up: RevMan, Harbord tests in STATA (version 17, StataCorp LP, College Station, TX, USA) using the metan and metabias packages, and GRADE analysis was performed in GRADEpro GDT software 2023 online (https://gradepro.org) [14,15]. Pubmed, Scopus, the Cochrane Library, and Web of Science (WoS) electronic databases were queried on July 5, 2023, with the same search string as previously [2]. The interpretation of the string by each database's search engine is in Appendix A.…”

“…It comprises three clinical presentations: ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevated myocardial infarction (NSTEMI), and unstable angina pectoris (UAP) [1]. A previous prospective Systematic Literature Review (SLR) and meta-analysis of prospective Randomized Con-trolled Trials (RCT) compared the 1-year follow-up clinical outcomes after Percutaneous Coronary Interventions (PCI) using non-drug-eluting Titanium-Nitride-Oxide-coated Stents (TiNOS) to treat patients with ACS [2]. The pooled Risk Ratios (RRs) showed that TiNOS was non-inferior to DES in terms of device-oriented Major Adverse Cardiac Events (MACE) rates and presented a lower risk of recurrent myocardial infarction (MI) at 1-year follow-up.…”

Five-year Efficacy and Safety of TiNO-Coated Stents Versus Drug-Eluting Stents in Acute Coronary Syndrome. A meta-analysis.

“…The SLR was conducted according to the principles defined in the Cochrane Handbook and the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) with the use of "Grading of Recommendations Assessment, Development, and Evaluation" (GRADE) (5)(6)(7)(8)(9)(10)(11)(12). The protocol and the previous article describe the detailed SLR and meta-analytic methods applied with 5-year outcomes, similar to those used with 1-year data except for aspects below (2,3). The primary reviewers of 5-year outcomes were F.D.…”

“…It has three clinical presentations: ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevated myocardial infarction (NSTEMI), and unstable angina pectoris (UAP) (1). A previous prospective Systematic Literature Review (SLR) and stratified meta-analysis of Randomized Controlled Trials (RCT) compared the clinical outcomes in patients presenting with ACS after reperfusion with Percutaneous Coronary Interventions (PCI) using Drug-Eluting Stents (DES) vs. non-drug-eluting Titanium-Nitride-Oxide-coated Stents (TiNOS) and one-year follow-up (2). The primary end-point was device-oriented Major Adverse Cardiac Events (MACE).…”