1. 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
- Author
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Pierluigi Omedè, Claudio Moretti, Antonio Colombo, Stefanie Schulz-Schüpke, Maurizio D'Amico, Alaide Chieffo, Federico Conrotto, Fabrizio Ugo, Seung-Jung Park, Sebastiano Gili, Gregg W. Stone, Maurizio Bertaina, Cheol Wahn Lee, Fabrizio D'Ascenzo, Gérard Helft, Roberto Garbo, Umberto Barbero, Sara Rettegno, Fiorenzo Gaita, Christian Templin, Giuseppe Biondi Zoccai, Adnan Kastrati, David Hildick-Smith, Mario Iannaccone, Gaelle Saint-Hilary, Mauro Gasparini, 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, and Gaita, Fiorenzo
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medicine.medical_specialty ,animal structures ,medicine.medical_treatment ,Myocardial Ischemia ,Hemorrhage ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Length of dual antiplatelet therapy ,Percutaneous coronary intervention ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Absorbable Implants ,Clinical endpoint ,medicine ,Humans ,Zotarolimus ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Network meta-analysis ,Randomized Controlled Trials as Topic ,DAPT duration ,business.industry ,Stent ,Drug-Eluting Stents ,Network meta-analysi ,medicine.disease ,BRS DES EES ZES ,Surgery ,Meta-analysis ,Cardiology ,Drug Therapy, Combination ,Stents ,DAPT ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,Mace ,medicine.drug - Abstract
Aims 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. Methods and results 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 (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. Conclusion 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.
- Published
- 2017
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