Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis

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• 作者：Tullio Palmerini ; MD^a ; Giuseppe Biondi-Zoccai ; MD^b ; Diego Della Riva ; MD^a ; Christoph Stettler ; MD^d ; Diego Sangiorgi ; MStat^a ; Fabrizio D'Ascenzo ; MD^e ; Prof Takeshi Kimura ; MD^f ; Carlo Briguori ; MD^g ; Manel Sabatè ; MD^h ; Prof Hyo-Soo Kim ; MDⁱ ; Antoinette De Waha ; MD^j ; Elvin Kedhi ; MD^k ; Pieter C Smits ; MD^k ; Christoph Kaiser ; MD^l ; Gennaro Sardella ; MD^c ; Antonino Marullo ; MD^b ; Ajay J Kirtane ; MD^m ; Prof Martin B Leon ; MD^m ; Prof Gregg W Stone ; MD^m ; ^{gs2184@columbia.edu}
• 刊名：The Lancet
• 出版年：2012
• 期刊代码：182_01406736
• 类别：med
• 出版时间：14-20 April, 2012
• 卷：379
• 期：9824
• 页码：1393-1402
• 文件大小：419 K

摘要

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Summary

Background

The relative safety of drug-eluting stents and bare-metal stents, especially with respect to stent thrombosis, continues to be debated. In view of the overall low frequency of stent thrombosis, large sample sizes are needed to accurately estimate treatment differences between stents. We compared the risk of thrombosis between bare-metal and drug-eluting stents.

Methods

For this network meta-analysis, randomised controlled trials comparing different drug-eluting stents or drug-eluting with bare-metal stents currently approved in the USA were identified through Medline, Embase, Cochrane databases, and proceedings of international meetings. Information about study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted.

Findings

49 trials including 50鈥?44 patients randomly assigned to treatment groups were analysed. 1-year definite stent thrombosis was significantly lower with cobalt-chromium everolimus eluting stents (CoCr-EES) than with bare-metal stents (odds ratio [OR] 0路23, 95%CI 0路13-0路41). The significant difference in stent thrombosis between CoCr-EES and bare-metal stents was evident as early as 30 days (OR 0路21, 95%CI 0路11-0路42) and was also significant between 31 days and 1 year (OR 0路27, 95%CI 0路08-0路74). CoCr-EES were also associated with significantly lower rates of 1-year definite stent thrombosis compared with paclitaxel-eluting stents (OR 0路28, 95%CI 0路16-0路48), permanent polymer-based sirolimus-eluting stents (OR 0路41, 95%CI 0路24-0路70), phosphorylcholine-based zotarolimus-eluting stents (OR 0路21, 95%CI 0路10-0路44), and Resolute zotarolimus-eluting stents (OR 0路14, 95%CI 0路03-0路47). At 2-year follow-up, CoCr-EES were still associated with significantly lower rates of definite stent thrombosis than were bare-metal (OR 0路35, 95%CI 0路17-0路69) and paclitaxel-eluting stents (OR 0路34, 95%CI 0路19-0路62). No other drug-eluting stent had lower definite thrombosis rates compared with bare-metal stents at 2-year follow-up.

Interpretation

In randomised studies completed to date, CoCr-EES has the lowest rate of stent thrombosis within 2 years of implantation. The finding that CoCr-EES also reduced stent thrombosis compared with bare-metal stents, if confirmed in future randomised trials, represents a paradigm shift.

Funding

The Cardiovascular Research Foundation.