Clinical outcomes with bioabsorbable polymer- Versus durable polymer-based drug-eluting and bare-metal stents

Evidence from a comprehensive network meta-analysis

Tullio Palmerini, Giuseppe Biondi-Zoccai, Diego Della Riva, Andrea Mariani, Manel Sabaté, Pieter C. Smits, Christoph Kaiser, Fabrizio D'Ascenzo, Giacomo Frati, Massimo Mancone, Philippe Genereux, Gregg W. Stone

Research output: Contribution to journalArticle

162 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)299-307
Number of pages9
JournalJournal of the American College of Cardiology
Volume63
Issue number4
DOIs
StatePublished - Feb 4 2014

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Stents
Polymers
Metals
Pharmaceutical Preparations
Drug-Eluting Stents
Myocardial Infarction
Thrombosis
Chromium
Network Meta-Analysis
Cobalt
Safety
Paclitaxel

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Palmerini, Tullio ; Biondi-Zoccai, Giuseppe ; Della Riva, Diego ; Mariani, Andrea ; Sabaté, Manel ; Smits, Pieter C. ; Kaiser, Christoph ; D'Ascenzo, Fabrizio ; Frati, Giacomo ; Mancone, Massimo ; Genereux, Philippe ; Stone, Gregg W. / Clinical outcomes with bioabsorbable polymer- Versus durable polymer-based drug-eluting and bare-metal stents : Evidence from a comprehensive network meta-analysis. In: Journal of the American College of Cardiology. 2014 ; Vol. 63, No. 4. pp. 299-307.
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title = "Clinical outcomes with bioabsorbable polymer- Versus durable polymer-based drug-eluting and bare-metal stents: Evidence from a comprehensive network meta-analysis",
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.",
author = "Tullio Palmerini and Giuseppe Biondi-Zoccai and {Della Riva}, Diego and Andrea Mariani and Manel Sabat{\'e} and Smits, {Pieter C.} and Christoph Kaiser and Fabrizio D'Ascenzo and Giacomo Frati and Massimo Mancone and Philippe Genereux and Stone, {Gregg W.}",
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Palmerini, T, Biondi-Zoccai, G, Della Riva, D, Mariani, A, Sabaté, M, Smits, PC, Kaiser, C, D'Ascenzo, F, Frati, G, Mancone, M, Genereux, P & Stone, GW 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, vol. 63, no. 4, pp. 299-307. https://doi.org/10.1016/j.jacc.2013.09.061

Clinical outcomes with bioabsorbable polymer- Versus durable polymer-based drug-eluting and bare-metal stents : Evidence from a comprehensive network meta-analysis. / Palmerini, Tullio; Biondi-Zoccai, Giuseppe; Della Riva, Diego; Mariani, Andrea; Sabaté, Manel; Smits, Pieter C.; Kaiser, Christoph; D'Ascenzo, Fabrizio; Frati, Giacomo; Mancone, Massimo; Genereux, Philippe; Stone, Gregg W.

In: Journal of the American College of Cardiology, Vol. 63, No. 4, 04.02.2014, p. 299-307.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical outcomes with bioabsorbable polymer- Versus durable polymer-based drug-eluting and bare-metal stents

T2 - 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.

PY - 2014/2/4

Y1 - 2014/2/4

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.

AB - 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.

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U2 - 10.1016/j.jacc.2013.09.061

DO - 10.1016/j.jacc.2013.09.061

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JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

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