Polymer‐free versus permanent polymer‐coated drug eluting stents for the treatment of coronary artery disease: A meta‐analysis of randomized trials

Nogic, Jason; Baey, Yi Wei; Nerlekar, Nitesh; Ha, Francis J.; Cameron, James D.; Nasis, Arthur; West, Nick E.J.; Brown, Adam

doi:10.1111/joic.12522

Cited by 12 publications

(11 citation statements)

References 30 publications

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“…This recent paper of more extensive randomized clinical trials allows us to conduct the current meta-analysis, which compares PF-DES to PC-DES, including PP and BP-DES. We discovered that patients who received the new stents had a reduced all-cause mortality rate, similar to what Nogic et al [ 45 ] discovered. However, this increase in survival was not due to a reduction in recurring ischemic episodes or cardiovascular deaths.…”

Section: Reviewsupporting

confidence: 86%

“…In particular, 1% of patients developed stent thrombosis, which could be attributed to the inclusion of a low-risk community of stable patients with confined outgrowths of cardiovascular problems. The vast majority of trials were underwhelming in assessing actual result metrics, and the greatest benefits of PF-DES were confirmed in trials encompassing subgroups of patients at greater risk [ 44 , 45 ].…”

Section: Reviewmentioning

confidence: 99%

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Clinical Outcomes of Polymer-Free Versus Polymer-Coated Drug-Eluting Stents in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis

Khatri¹,

Kumar²,

Mahfooz³

et al. 2023

Cureus

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Drug-eluting stents have transformed the treatment of coronary artery disease (CAD), and there are two types: polymer-free and polymer-coated stents. Polymer-free stents have a coating that is quickly absorbed by the body, whereas polymer-coated stents have a coating that remains on the stent surface. This meta-analysis and systematic review aimed to compare the clinical outcomes of these two stent types in patients with coronary artery disease. The literature and abstracts from significant databases were reviewed to compare polymer-free drug-eluting stents (PF-DES) and polymer-coated drug-eluting stents (PC-DES) for the treatment of coronary artery disease (CAD). The primary efficacy endpoints of the study were all-cause mortality and deaths from cardiovascular and non-cardiovascular causes. Among the secondary outcomes were incidences of myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), stent thrombosis, stroke, and major adverse cardiovascular events (MACEs). In terms of the primary outcomes, the combined analysis revealed a marginally lower risk of all-cause mortality (relative risk, RR (95% CI) = 0.92 (0.85, 1.00), p = 0.05, I 2 = 0%) with the use of PF-DES versus PC-DES. Nonetheless, there was no significant difference in cardiovascular mortality (RR (95% CI) = 0.97 (0.87, 1.08)) or non-cardiovascular mortality (RR (95% CI) = 0.87 (0.69, 1.10), p = 0.25, I 2 = 9%) between the groups. Furthermore, univariate meta-regression revealed that male gender and prior myocardial infarction were independently associated with an increased risk of all-cause mortality and cardiovascular disease. According to the current meta-analysis, no statistically significant differences existed in PF-DES and PC-DES outcomes. More extensive research is needed to investigate these findings further and establish their validity.

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Section: Reviewsupporting

confidence: 86%

Section: Reviewmentioning

confidence: 99%

Clinical Outcomes of Polymer-Free Versus Polymer-Coated Drug-Eluting Stents in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis

Khatri¹,

Kumar²,

Mahfooz³

et al. 2023

Cureus

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“…Specifically, over half of the patients included in the analysis were recruited in trials published before 2013 utilizing older generation stents, which have shown inferior results to newer generation stents. Additionally, different stent polymer coating strategies have shown different clinical outcomes 9,10 . In contrast to our study, given the localized nature of VCOR and government and private contractual arrangements, although not specified in the registry there were only limited DES available all of which were second generation.…”

Section: Discussionmentioning

confidence: 67%

“…Additionally, different stent polymer coating strategies have shown different clinical outcomes. 9,10 In contrast to our study, given the localized nature of VCOR and government and private contractual arrangements, although not specified in the registry there were only limited DES available all of which were second generation. Given the low event rates, more recently published data, including ours and the utilization of newer DES generations, repeat meta-analysis of current data should be attempted to assess this hypothesis further.…”

Section: Discussionmentioning

confidence: 72%

Diabetes mellitus is independently associated with early stent thrombosis in patients undergoing drug eluting stent implantation: Analysis from the Victorian cardiac outcomes registry

Nogic

Nerlekar

Soon

et al. 2021

Cathet Cardio Intervent

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Background: Diabetes mellitus (DM) is a predictor of restenosis and late stent thrombosis (ST) in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting-stents (DES). Real-world data on rates of early ST is lacking. We compared clinical outcomes of patients with and without DM from the Victorian cardiac outcomes registry.Methods: Consecutive patients undergoing PCI with DES were analyzed with primary outcome being ST at 30-days. Secondary outcomes including major adverse cardiovascular events (MACE) and all-cause mortality.Results: Of 43,209 patients included, 9730 (22.5%) had DM. At 30 days, DM was independently associated with higher rates of early ST (0.7% vs. 0.5%) OR 1.41 (95% confidence interval; 1.05-1.87, p = 0.02), MACE (4.1% vs. 3.5%, p = 0.004) and mortality (1.9% vs. 1.5%, p = 0.01). Increased risk was not simply due to treatment.Patients with DM requiring insulin were equally affected in regard to MACE (4.7% vs.3.9%, p = 0.069) and mortality (1.9%, vs. 1.8%, p = 0.746). On National Death Index linkage, patients with DM had increased all-cause mortality over five-year follow-up (OR 1.69 CI 1.55-1.83, p = < 0.001). Conclusion:In this large real-world-registry, DM was an independent predictor of early ST, MACE and mortality at 30 days. These data suggest additional therapeutic strategies are required to reduce the risk of early complications in patients with DM undergoing PCI with DES.

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“…Clinical outcomes following revascularization with percutaneous coronary intervention (PCI) have improved significantly over the last three decades, driven by advances in stent design, improved PCI techniques, and enhanced adjuvant pharmacotherapies [1,2]. However, recurrent cardiovascular events remain an ongoing clinical concern, with around half of these either attributable to the previously stented segment or residual disease located within the target vessel [3].…”

Section: Introductionmentioning

confidence: 99%

Fractional Flow Reserve following Percutaneous Coronary Intervention

Thakur

Khav

Comella

et al. 2020

Journal of Interventional Cardiology

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Fractional flow reserve (FFR) is routinely used to determine lesion severity prior to percutaneous coronary intervention (PCI). However, there is an increasing recognition that FFR may also be useful following PCI to identify mechanisms leading to restenosis and the need for repeat revascularization. Post-PCI FFR is associated with the presence and severity of stent under-expansion and may help identify peri-stent-related complications. FFR pullback may also unmask other functionally significant lesions within the target vessel that were not appreciable on angiography. Recent studies have confirmed the prognostic utility of performing routine post-PCI FFR and suggest possible interventional targets that would improve stent durability. In this review, we detail the theoretical basis underlying post-PCI FFR, provide practical tips to facilitate measurement, and discuss the growing evidence supporting its use.

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Polymer‐free versus permanent polymer‐coated drug eluting stents for the treatment of coronary artery disease: A meta‐analysis of randomized trials

Abstract: PF-DES are as safe and efficacious as PP-DES for the treatment of patients with CAD, but do not significantly reduce late ischemic complications.

Cited by 12 publications

References 30 publications

Clinical Outcomes of Polymer-Free Versus Polymer-Coated Drug-Eluting Stents in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis

Clinical Outcomes of Polymer-Free Versus Polymer-Coated Drug-Eluting Stents in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis

Diabetes mellitus is independently associated with early stent thrombosis in patients undergoing drug eluting stent implantation: Analysis from the Victorian cardiac outcomes registry

Fractional Flow Reserve following Percutaneous Coronary Intervention

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