Impact of design of coronary stents and length of dual antiplatelet therapies on ischaemic and bleeding events: a network meta-analysis of 64 randomized controlled trials and 102 735 patients.

D'Ascenzo, Fabrizio; Iannaccone, Mario; Saint-Hilary, Gaelle; Bertaina, Maurizio; Schulz-Schüpke, Stefanie; Wahn Lee, Cheol; Chieffo, Alaide; Helft, Gerard; Gili, Sebastiano; Barbero, Umberto; Biondi Zoccai, Giuseppe; Moretti, Claudio; Ugo, Fabrizio; D'Amico, Maurizio; Garbo, Roberto; Stone, Gregg; Rettegno, Sara; Omedè, Pierluigi; Conrotto, Federico; Templin, Christian; Colombo, Antonio; Park, Seung-Jung; Kastrati, Adnan; Hildick-Smith, David; Gasparini, Mauro; Gaita, Fiorenzo

doi:10.1093/eurheartj/ehx437

journal article

Title:: Impact of design of coronary stents and length of dual antiplatelet therapies on ischaemic and bleeding events: a network meta-analysis of 64 randomized controlled trials and 102 735 patients.
Document type:: Journal Article; Article
Author(s):: D'Ascenzo, Fabrizio; Iannaccone, Mario; Saint-Hilary, Gaelle; Bertaina, Maurizio; Schulz-Schüpke, Stefanie; Wahn Lee, Cheol; Chieffo, Alaide; Helft, Gerard; Gili, Sebastiano; Barbero, Umberto; Biondi Zoccai, Giuseppe; Moretti, Claudio; Ugo, Fabrizio; D'Amico, Maurizio; Garbo, Roberto; Stone, Gregg; Rettegno, Sara; Omedè, Pierluigi; Conrotto, Federico; Templin, Christian; Colombo, Antonio; Park, Seung-Jung; Kastrati, Adnan; Hildick-Smith, David; Gasparini, Mauro; Gaita, Fiorenzo
Abstract:: The differential impact on ischaemic and bleeding events of the type of drug-eluting stent [durable polymer stents [DES] vs. biodegradable polymer stents vs. bioresorbable scaffolds (BRS)] and length of dual antiplatelet therapy (DAPT) remains to be defined.Randomized controlled trials comparing different types of DES and/or DAPT durations were selected. The primary endpoint was Major Adverse Cardiovascular Events (MACE) [a composite of death, myocardial infarction (MI), and target vessel revascularization]. Definite stent thrombosis (ST) and single components of MACE were secondary endpoints. The arms of interest were: BRS with 12 months of DAPT (12mDAPT), biodegradable polymer stent with 12mDAPT, durable polymer stent [everolimus-eluting (EES), zotarolimus-eluting (ZES)] with 12mDAPT, EES/ZES with <12 months of DAPT, and EES/ZES with >12 months of DAPT (DAPT > 12 m). Sixty-four studies with 150 arms and 102 735 patients were included. After a median follow-up of 20 months, MACE rates were similar in the different arms of interest. EES/ZES with DAPT > 12 m reported a lower incidence of MI than the other groups, while BRS showed a higher rate of ST when compared to EES/ZES, irrespective of DAPT length. A higher risk of major bleedings was observed for DAPT > 12 m as compared to shorter DAPT.Durable and biodegradable polymer stents along with BRS report a similar rate of MACE irrespective of DAPT length. Fewer MI are observed with EES/ZES with DAPT > 12 m, while a higher rate of ST is reported for BRS when compared to EES/ZES, independently from DAPT length. Stent type may partially affect the outcome together with DAPT length.
Journal title abbreviation:: Eur Heart J
Year:: 2017
Journal volume:: 38
Journal issue:: 42
Pages contribution:: 3160-3172
Language:: eng
Fulltext / DOI:: doi:10.1093/eurheartj/ehx437
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/29020300
Print-ISSN:: 0195-668X
TUM Institution:: Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2017