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Clinical outcomes with bioabsorbable polymer- versus durable polymer-based drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis.
J Am Coll Cardiol 2014; 63(4):299-307JACC

Abstract

OBJECTIVES

This study sought to investigate the relative safety and efficacy of bioabsorbable polymer (BP)-based biolimus-eluting stents (BES) versus durable-polymer (DP)-drug-eluting stents (DES) and bare-metal stents (BMS) by means of a network meta-analysis.

BACKGROUND

Studies have suggested that BP-BES might reduce the risk of stent thrombosis (ST) and late adverse outcomes compared with first-generation DES. However, the relative safety and efficacy of BP-BES versus newer-generation DES coated with more biocompatible DP have not been investigated in depth.

METHODS

Randomized controlled trials comparing BP-BES versus currently U.S.-approved DES or BMS were searched through MEDLINE, EMBASE, and Cochrane databases. Information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted.

RESULTS

Data from 89 trials including 85,490 patients were analyzed. At 1-year follow-up, BP-BES were associated with lower rates of cardiac death/myocardial infarction (MI), MI, and target vessel revascularization (TVR) than BMS and lower rates of TVR than fast-release zotarolimus-eluting stents. The BP-BES had similar rates of cardiac death/MI, MI, and TVR compared with other second-generation DP-DES but higher rates of 1-year ST than cobalt-chromium everolimus-eluting stents (CoCr-EES). The BP-BES were associated with improved late outcomes compared with BMS and paclitaxel-eluting stents, considering the latest follow-up data available, with nonsignificantly different outcomes compared with other DP-DES although higher rates of definite ST compared with CoCr-EES.

CONCLUSIONS

In this large-scale network meta-analysis, BP-BES were associated with superior clinical outcomes compared with BMS and first-generation DES and similar rates of cardiac death/MI, MI, and TVR compared with second-generation DP-DES but higher rates of definite ST than CoCr-EES.

Authors+Show Affiliations

Dipartimento Cardiovascolare, Policlinico Sant' Orsola, Bologna, Italy.Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.Dipartimento Cardiovascolare, Policlinico Sant' Orsola, Bologna, Italy.Dipartimento Cardiovascolare, Policlinico Sant' Orsola, Bologna, Italy.Hospital Clinic, Barcelona, Spain.Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands.University Hospital Basel, Basel, Switzerland.Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy.Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of Angiocardioneurology, IRCCS "Neuromed", Pozzilli (IS), Italy.Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada.Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York. Electronic address: gs2184@columbia.edu.

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

24211507

Citation

Palmerini, Tullio, et al. "Clinical Outcomes With Bioabsorbable Polymer- Versus Durable Polymer-based Drug-eluting and Bare-metal Stents: Evidence From a Comprehensive Network Meta-analysis." Journal of the American College of Cardiology, vol. 63, no. 4, 2014, pp. 299-307.
Palmerini T, Biondi-Zoccai G, Della Riva D, et al. Clinical outcomes with bioabsorbable polymer- versus durable polymer-based drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis. J Am Coll Cardiol. 2014;63(4):299-307.
Palmerini, T., Biondi-Zoccai, G., Della Riva, D., Mariani, A., Sabaté, M., Smits, P. C., ... Stone, G. W. (2014). Clinical outcomes with bioabsorbable polymer- versus durable polymer-based drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis. Journal of the American College of Cardiology, 63(4), pp. 299-307. doi:10.1016/j.jacc.2013.09.061.
Palmerini T, et al. Clinical Outcomes With Bioabsorbable Polymer- Versus Durable Polymer-based Drug-eluting and Bare-metal Stents: Evidence From a Comprehensive Network Meta-analysis. J Am Coll Cardiol. 2014 Feb 4;63(4):299-307. PubMed PMID: 24211507.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical outcomes with bioabsorbable polymer- versus durable polymer-based drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis. AU - Palmerini,Tullio, AU - Biondi-Zoccai,Giuseppe, AU - Della Riva,Diego, AU - Mariani,Andrea, AU - Sabaté,Manel, AU - Smits,Pieter C, AU - Kaiser,Christoph, AU - D'Ascenzo,Fabrizio, AU - Frati,Giacomo, AU - Mancone,Massimo, AU - Genereux,Philippe, AU - Stone,Gregg W, Y1 - 2013/11/06/ PY - 2013/07/20/received PY - 2013/09/03/revised PY - 2013/09/17/accepted PY - 2013/11/12/entrez PY - 2013/11/12/pubmed PY - 2014/3/29/medline KW - BES KW - BP KW - CI KW - CoCr-EES KW - DP KW - OR KW - PC-ZES KW - PES KW - PtCr-EES KW - RCT KW - SES KW - ST KW - TVR KW - bare-metal stent(s) KW - bioabsorbable polymers KW - biolimus-eluting stent(s) KW - cobalt-chromium everolimus-eluting stent(s) KW - credible interval KW - drug-eluting stent(s) KW - durable polymers KW - meta-analysis KW - odds ratio KW - paclitaxel-eluting stent(s) KW - phosphorylcholine-based zotarolimus-eluting stent(s) KW - platinum chromium everolimus-eluting stent(s) KW - randomized controlled trial KW - sirolimus-eluting stent(s) KW - stent thrombosis KW - target vessel revascularizations SP - 299 EP - 307 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 63 IS - 4 N2 - OBJECTIVES: This study sought to investigate the relative safety and efficacy of bioabsorbable polymer (BP)-based biolimus-eluting stents (BES) versus durable-polymer (DP)-drug-eluting stents (DES) and bare-metal stents (BMS) by means of a network meta-analysis. BACKGROUND: Studies have suggested that BP-BES might reduce the risk of stent thrombosis (ST) and late adverse outcomes compared with first-generation DES. However, the relative safety and efficacy of BP-BES versus newer-generation DES coated with more biocompatible DP have not been investigated in depth. METHODS: Randomized controlled trials comparing BP-BES versus currently U.S.-approved DES or BMS were searched through MEDLINE, EMBASE, and Cochrane databases. Information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted. RESULTS: Data from 89 trials including 85,490 patients were analyzed. At 1-year follow-up, BP-BES were associated with lower rates of cardiac death/myocardial infarction (MI), MI, and target vessel revascularization (TVR) than BMS and lower rates of TVR than fast-release zotarolimus-eluting stents. The BP-BES had similar rates of cardiac death/MI, MI, and TVR compared with other second-generation DP-DES but higher rates of 1-year ST than cobalt-chromium everolimus-eluting stents (CoCr-EES). The BP-BES were associated with improved late outcomes compared with BMS and paclitaxel-eluting stents, considering the latest follow-up data available, with nonsignificantly different outcomes compared with other DP-DES although higher rates of definite ST compared with CoCr-EES. CONCLUSIONS: In this large-scale network meta-analysis, BP-BES were associated with superior clinical outcomes compared with BMS and first-generation DES and similar rates of cardiac death/MI, MI, and TVR compared with second-generation DP-DES but higher rates of definite ST than CoCr-EES. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/24211507/Clinical_outcomes_with_bioabsorbable_polymer__versus_durable_polymer_based_drug_eluting_and_bare_metal_stents:_evidence_from_a_comprehensive_network_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(13)05752-5 DB - PRIME DP - Unbound Medicine ER -