Efficacy and safety of polymer-free stent versus polymer-permanent drug-eluting stent in patients with acute coronary syndrome: a meta-analysis of randomized control trials

Objective: The aim was to evaluate the efficacy and safety of duration of dual antiplatelet therapy (DAPT) for patients who received percutaneous coronary intervention (PCI) with a drug-eluting stent. Background: The optimal duration of DAPT to balance the risk of ischemia and bleeding in CAD patients undergoing drug-eluting stent (DES) implantation remains controversial. Methods: PubMed, Cochrane Library, Web of Science, Clinicaltrials.gov, CNKI and Wanfang Databases were searched for randomized controlled trials of comparing different durations of DAPT after DES implantation. Primary outcomes were major adverse cardiac and cerebrovascular events (MACCE), and major bleeding, and were pooled by Bayes network meta-analysis. Net adverse clinical and cerebral events were used to estimate the surface under the cumulative ranking (SUCRA) curves. The subgroup analysis based on clinical status, follow-up and area was conducted using traditional pairwise meta-analysis. Results: A total of nineteen trials (n=51,035) were included, involving six duration strategies. The network metaanalysis showed that T2 (<6-month DAPT followed by aspirin, HR:1.51, 95%CI:1.02-2.22), T3 (standard 6-month DAPT, HR:1.47, 95%CI:1.14-1.91), T4 (standard 12-month DAPT, HR:1.41, 95%CI:1.15-1.75) and T5 (18-24 months DAPT, HR:1.47, 95%CI:1.09-1.97) was associated with significantly increased risk of MACCE compared to T6 (>24-month DAPT). However, no significant difference was found in MACCE risk between T1 (<6-month DAPT followed by P2Y12 monotherapy) and T6. Moreover, T5 was associated with significantly increased risk of bleeding compared to T1(RR:3.94, 95%CI:1.66-10.60), T2(RR:3.65, 95%CI:1.32-9.97), T3(RR:1.93, 95%CI:1.21-3.50) and T4(RR:1.89, 95%CI:1.15-3.30). The cumulative probabilities showed that T6(85.0%), T1(78.3%) and T4(44.5%) were the most efficacious treatment compared to the other durations. In the ACS (<50%) subgroup, T1 was observed to significantly reduce the risk of major bleeding compared to T4, but not in the ACS (≥50%) subgroup. Conclusions: Compared with other durations, short DAPT followed by P2Y12 inhibitor monotherapy showed non-inferiority, with a lower risk of bleeding and not associated with an increased MACCE. In addition, the risk of major bleeding increased significantly, starting with DAPT for 18-month. Compared with the short-term treatment, patients with ACS with the standard 12-month treatment have a better prognosis, including lower bleeding rate and the decreased risk of MACCE. Due to study's limitations, the results should be verified in different risk populations.

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Efficacy and Safety of Unfractionated Heparin Plus Glycoprotein IIb/IIIa Inhibitors During Revascularization for an Acute Coronary Syndrome: A Meta-Analysis of Randomized Trials Performed With Stents and Thienopyridines

Clinical Cardiology ◽

10.1002/clc.20974 ◽

2011 ◽

Vol 35 (2) ◽

pp. 93-100 ◽

Cited By ~ 8

Author(s):

David E. Winchester ◽

William D. Brearley ◽

Xuerong Wen ◽

Ki E. Park ◽

Anthony A. Bavry

Keyword(s):

Acute Coronary Syndrome ◽

Unfractionated Heparin ◽

Randomized Trials ◽

Meta Analysis ◽

Efficacy And Safety ◽

Coronary Syndrome

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Endovascular Treatment with Limus Eluting Stents in Patients with Acute Coronary Syndrome

Russian Sklifosovsky Journal Emergency Medical Care ◽

10.23934/2223-9022-2019-8-1-45-52 ◽

2019 ◽

Vol 8 (1) ◽

pp. 45-52

Author(s):

M. V. Chernyayev ◽

A. G. Faybushevich ◽

Y. S. Muzganova

Keyword(s):

Coronary Heart Disease ◽

Acute Coronary Syndrome ◽

Heart Disease ◽

Drug Therapy ◽

Fatal Outcome ◽

Drug Eluting Stent ◽

Health State ◽

Medium Term ◽

Coronary Syndrome ◽

Drug Eluting

BACKGROUND Coronary heart disease is one of the main causes of the population’s disability and mortality in Russia and abroad. Revascularization with coronary stents in the course of the most suitable drug therapy is one of the most important treatments of coronary heart disease. It is essential to pay special attention to the research results of using modern stents, in particular, the frst Russian drug-eluting stent “CALYPSO”.AIM OF STUDY To study immediate and medium-term results of Limus-eluting stents procedure in patients with acute coronary syndrome.MATERIAL AND METHODS 304 patients with acute coronary syndrome were included into the research and were divided into 2 groups. The frst group consisted of 156 patients with CALYPSO stent (Angioline, Russia). The other group consisted of 148 patients who had undergone revascularization with the XIENCE stent (Abbot Vascular, USA). Their health state was monitored via phone 3, 6, 9 and 12 months later. After the discharge from the hospital, the drug therapy was prescribed, and instrumental procedures of diagnostics were planned for the period of 9–12 months. According to the results of the examination, patients with suspected or confrmed myocardial ischemia underwent follow-up coronary angiography.RESULTS The success of implantation was 98.63% in the frst group, and 99.4% in the second group. One fatal outcome occurred in both groups during hospitalization (thus making 0.64% и 0.67%). The placement of the CALYPSO stent in distal parts of coronary arteries requested signifcantly less time and contrast. Medium-term results of stenting in both groups appeared to be comparable (thus, all cause death 3 (1.92%) and 2 (1.35%), restenosis >50% 3 (1.92%) and 3 (2 %), late thrombosis — 0 in both groups, cardiac death — 0 in both groups. End points (MACE) in both groups were 1.28% and 0.67%.CONCLUSION Taking into consideration immediate and medium-term results it can be concluded that domestic stents (CALYPSO) are comparable to stents XIENCE. The CALYPSO stent is more advantageous than the XIENCE in the delivery to the lesion focus while performing the procedure in distal ﬂow.

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