British Journal of Medicine and Medical Research, ISSN: 2231-0614,Vol.: 14, Issue.: 4
Meta-analysis of Trials Comparing Drug-eluting Stents with Bare Metal Stents: Safety and Efficacy
Hussein Rayatzadeh1,2, Ali Reza Khoshdel1*, Sam Chitsaz2, Ali Pasha Meysamie2 and Jamshid Bagheri2 1Department of Epidemiology, AJA University of Medical Sciences, Tehran, Iran. 2Cardiovascular Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Hussein Rayatzadeh1,2, Ali Reza Khoshdel1*, Sam Chitsaz2, Ali Pasha Meysamie2 and Jamshid Bagheri2
1Department of Epidemiology, AJA University of Medical Sciences, Tehran, Iran.
2Cardiovascular Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
(1) Jingli Xu, College of Pharmacy, University of New Mexico, USA.
(1) Adham Ibrahim Ahmed, University of Palestine, Palestine.
(2) Askın Ender Topal, Dicle University, Turkey.
(3) Marco Matteo Ciccone, University of Bari, Italy.
Complete Peer review History: http://sciencedomain.org/review-history/13647
Background: Effects of drug-eluting stents (DESs) on clinical outcomes as well as stent thrombosis are still under debate.
Methods: Our meta-analysis included 26 randomized trials comparing DESs with bare metal stents (BMSs). The endpoints analyzed were all-cause mortality, cardiac death, myocardial infarction (MI), target lesion (TLR) and target vessel (TVR) revascularization, restenosis, and stent thrombosis.
Results: In-stent (Risk Ratio = 0.23 [95% confidence interval: 0.17 - 0.32]) and in-segment restenosis (RR = 0.31 [0.24 - 0.40]) significantly reduced in patients with DESs compared with BMSs. Nonetheless, the all-cause mortality (RR = 0.98 [0.79 - 1.21]) and cardiac death (RR = 0.93 [0.71 - 1.21]) were not significantly different for patients receiving DESs compared with BMSs. DESs versus BMSs resulted in a significant decrease in MI (RR = 0.79 [0.67 - 0.93]), TLR (RR = 0.33 [0.29 - 0.38]), and TVR (RR = 0.47 [0.42 - 0.52]). Stent thrombosis incidence that did not differ in DESs versus BMSs until the first year after implantation, showed an upward trend in DESs compared with BMSs from then on (RR = 3.09 [1.37 - 6.99]).
Conclusions: The use of DESs versus BMSs led to benefits in angiographic restenosis and clinical outcomes. However, higher incidence of long-term stent thrombosis warrants their cautious usage in patients at high-risk of stent thrombosis.
Drug-eluting stent; bare metal stent; safety; efficacy; meta-analysis.
Full Article - PDF Page 1-19
DOI : 10.9734/BJMMR/2016/24622Review History Comments