Stent Thrombosis with Biodegradable Polymer Drug-Eluting Stents versus Durable Polymer Sirolimus-Eluting Stents: An Update Meta-Analysis

Abstract

Objective: Durable polymer sirolimus-eluting stents (DP-SES) are associated with a low risk of stent thrombosis; biodegradable polymer drug-eluting stents (BP-DES) were designed to reduce these risks. However, their benefits are still variable. Method: We undertook a meta-analysis of randomized trials identified by systematic searches of Medline, Embase, and the Cochrane Database. Results: Eleven studies (9,676 patients) with a mean follow-up of 22.6 months were included. Overall, compared with DP-SES, BP-DES significantly lowered the rate of definite or probable stent thrombosis (RR, 0.73; 95% CI, 0.55-0.97; p = 0.03; I² = 0.0%) due to a decreased risk of very late stent thrombosis (RR, 0.26; 95% CI, 0.11-0.63; p = 0.00; I² = 0.0%). However, BP-DES were associated with a comparable rate of early and late stent thrombosis. Meanwhile, BP-DES were associated with a broadly equivalent risk of target vessel revascularization (RR, 0.90; 95% CI, 0.78-1.03; p = 0.13; I² = 0.0%), cardiac death (RR, 0.89; 95% CI, 0.72-1.09; p = 0.24; I² = 0.0%), myocardial infarction (RR, 1.03; 95% CI, 0.84-1.26; p = 0.79; I² = 0.0%), and major adverse cardiac events (MACE; RR, 0.91; 95% CI, 0.83-1.0; p = 0.08; I² = 0.0%). Furthermore, angiographic data showed that in-stent and in-segment late luminal loss were similar between the two groups. Conclusions: Compared with DP-SES, BP-DES were associated with a lower rate of very late stent thrombosis and an equivalent risk of MACE. Larger randomized studies are needed to confirm this finding.

Novel sirolimus-eluting stent Prolim® with a biodegradable polymer in the all-comers population: one year clinical results with quantitative coronary angiography and optical coherence tomography analysis

“…Presently, stent thrombosis in second or third generation stents is a rare clinical scenario [ 23 ]. Also, as confirmed in several meta-analyses BP-DES compared with DP-DES are associated with a lower rate of very late stent thrombosis and an equivalent risk of MACE [ 24 , 25 ]. This probably might be associated with the fact that over time, the drug-coated polymers of BP-DES can gradually degrade into completely harmless CO 2 and H 2 O molecules that are excreted from a patient’s body.…”

Long-term cardiovascular outcomes of biodegradable polymer drug eluting stents in patients with diabetes versus non-diabetes mellitus: a meta-analysis

“…At last, several meta-analysis have compared BP-DES with durable polymer DES [ 34 , 35 ], however, this is the first meta-analysis till date to compare the cardiovascular outcomes in DM versus non-DM participants who were treated with BP-DES.…”

Biodegradable polymer drug-eluting stents versus first-generation durable polymer drug-eluting stents

“…Another study showed BP-DES to be more effective in reducing MACEs and ST than DP-DES during the long term. [ 25 ] Even the study published by Zhu et al [ 26 ] showed BP-DES to be associated with a lower rate of very late ST. However, the authors suggested further studies to confirm their findings.…”