Biodegradable-polymer drug-eluting stents vs. bare metal stents vs. durable-polymer drug-eluting stents: a systematic review and Bayesian approach network meta-analysis
Background The aim of this study was to compare the safety and efficacy of biodegradable-polymer (BP) drug-eluting stents (DES), bare metal stents (BMS), and durable-polymer DES in patients undergoing coronary revascularization, we performed a systematic review and network meta-analysis using a Baye...
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| Veröffentlicht in: | European heart journal 2014-05, Vol.35 (17), p.1147-1158 |
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| creator | Kang, Si-Hyuck Park, Kyung Woo Kang, Do-Yoon Lim, Woo-Hyun Park, Kyung Taek Han, Jung-Kyu Kang, Hyun-Jae Koo, Bon-Kwon Oh, Byung-Hee Park, Young-Bae Kandzari, David E. Cohen, David J. Hwang, Seung-Sik Kim, Hyo-Soo |
| description | Background
The aim of this study was to compare the safety and efficacy of biodegradable-polymer (BP) drug-eluting stents (DES), bare metal stents (BMS), and durable-polymer DES in patients undergoing coronary revascularization, we performed a systematic review and network meta-analysis using a Bayesian framework.
Methods and results
Study stents included BMS, paclitaxel-eluting (PES), sirolimus-eluting (SES), endeavor zotarolimus-eluting (ZES-E), cobalt–chromium everolimus-eluting (CoCr-EES), platinium–chromium everolimus-eluting (PtCr-EES), resolute zotarolimus-eluting (ZES-R), and BP biolimus-eluting stents (BP-BES). After a systematic electronic search, 113 trials with 90 584 patients were selected. The principal endpoint was definite or probable stent thrombosis (ST) defined according to the Academic Research Consortium within 1 year.
Results
Biodegradable polymer-biolimus-eluting stents [OR, 0.56; 95% credible interval (CrI), 0.33–0.90], SES (OR, 0.53; 95% CrI, 0.38–0.73), CoCr-EES (OR, 0.34; 95% CrI, 0.23–0.52), and PtCr-EES (OR, 0.31; 95% CrI, 0.10–0.90) were all superior to BMS in terms of definite or probable ST within 1 year. Cobalt–chromium everolimus-eluting stents demonstrated the lowest risk of ST of all stents at all times after stent implantation. Biodegradable polymer-biolimus-eluting stents was associated with a higher risk of definite or probable ST than CoCr-EES (OR, 1.72; 95% CrI, 1.04–2.98). All DES reduced the need for repeat revascularization, and all but PES reduced the risk of myocardial infarction compared with BMS.
Conclusions
All DESs but PES and ZES-E were superior to BMS in terms of ST within 1 year. Cobalt–chromium everolimus-eluting stents was safer than any DES even including BP-BES. Our results suggest that not only the biodegradability of polymer, but the optimal combination of stent alloy, design, strut thickness, polymer, and drug all combined determine the safety of DES. |
| doi_str_mv | 10.1093/eurheartj/eht570 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_1521336548</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/eurheartj/eht570</oup_id><sourcerecordid>1521336548</sourcerecordid><originalsourceid>FETCH-LOGICAL-o177t-c913d4dd639b09171ead9a1390a7813f0ef55f218d1d5100f5956dd779911523</originalsourceid><addsrcrecordid>eNqFkclOwzAQhi0EgrLcOSEfkVDAU8dOzA0Qm4TEpQdu0bSetIFs2E5R3ojHJNBSceM0o5lvFv0_Y8cgzkEYeUGdWxC68HpBi6ASscVGoMbjyOhYbbORAKMirdOXPbbv_asQItWgd9neOI6VAaNH7PO6aCzNHVqclhS1TdlX5Lh13TyisgtFPec-UB08X_pzPkVHvKKA5d-q7dx_05ccue-HvMJQzLijZUEfHGvLr7EnX2DNsW1dg7MFryl8NO7t506ENZa9L_wh28mx9HS0jgdscnc7uXmInp7vH2-unqIGkiREMwPSxtZqaabCQAKE1iBIIzBJQeaCcqXyMaQWrAIhcmWUtjZJjIFBOnnATldrh1_eO_Ihqwo_o7LEmprOZwMDUmoVpwN6ska7aUU2a11RoeuzX3EH4GwFNF276YLIvq3LNtZlK-vkF_wlkS0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1521336548</pqid></control><display><type>article</type><title>Biodegradable-polymer drug-eluting stents vs. bare metal stents vs. durable-polymer drug-eluting stents: a systematic review and Bayesian approach network meta-analysis</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>Kang, Si-Hyuck ; Park, Kyung Woo ; Kang, Do-Yoon ; Lim, Woo-Hyun ; Park, Kyung Taek ; Han, Jung-Kyu ; Kang, Hyun-Jae ; Koo, Bon-Kwon ; Oh, Byung-Hee ; Park, Young-Bae ; Kandzari, David E. ; Cohen, David J. ; Hwang, Seung-Sik ; Kim, Hyo-Soo</creator><creatorcontrib>Kang, Si-Hyuck ; Park, Kyung Woo ; Kang, Do-Yoon ; Lim, Woo-Hyun ; Park, Kyung Taek ; Han, Jung-Kyu ; Kang, Hyun-Jae ; Koo, Bon-Kwon ; Oh, Byung-Hee ; Park, Young-Bae ; Kandzari, David E. ; Cohen, David J. ; Hwang, Seung-Sik ; Kim, Hyo-Soo</creatorcontrib><description>Background
The aim of this study was to compare the safety and efficacy of biodegradable-polymer (BP) drug-eluting stents (DES), bare metal stents (BMS), and durable-polymer DES in patients undergoing coronary revascularization, we performed a systematic review and network meta-analysis using a Bayesian framework.
Methods and results
Study stents included BMS, paclitaxel-eluting (PES), sirolimus-eluting (SES), endeavor zotarolimus-eluting (ZES-E), cobalt–chromium everolimus-eluting (CoCr-EES), platinium–chromium everolimus-eluting (PtCr-EES), resolute zotarolimus-eluting (ZES-R), and BP biolimus-eluting stents (BP-BES). After a systematic electronic search, 113 trials with 90 584 patients were selected. The principal endpoint was definite or probable stent thrombosis (ST) defined according to the Academic Research Consortium within 1 year.
Results
Biodegradable polymer-biolimus-eluting stents [OR, 0.56; 95% credible interval (CrI), 0.33–0.90], SES (OR, 0.53; 95% CrI, 0.38–0.73), CoCr-EES (OR, 0.34; 95% CrI, 0.23–0.52), and PtCr-EES (OR, 0.31; 95% CrI, 0.10–0.90) were all superior to BMS in terms of definite or probable ST within 1 year. Cobalt–chromium everolimus-eluting stents demonstrated the lowest risk of ST of all stents at all times after stent implantation. Biodegradable polymer-biolimus-eluting stents was associated with a higher risk of definite or probable ST than CoCr-EES (OR, 1.72; 95% CrI, 1.04–2.98). All DES reduced the need for repeat revascularization, and all but PES reduced the risk of myocardial infarction compared with BMS.
Conclusions
All DESs but PES and ZES-E were superior to BMS in terms of ST within 1 year. Cobalt–chromium everolimus-eluting stents was safer than any DES even including BP-BES. Our results suggest that not only the biodegradability of polymer, but the optimal combination of stent alloy, design, strut thickness, polymer, and drug all combined determine the safety of DES.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/eht570</identifier><identifier>PMID: 24459196</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Absorbable Implants ; Bayes Theorem ; Drug-Eluting Stents ; Everolimus ; Humans ; Myocardial Infarction - therapy ; Myocardial Revascularization - methods ; Paclitaxel - administration & dosage ; Prosthesis Failure ; Randomized Controlled Trials as Topic ; Sirolimus - administration & dosage ; Sirolimus - analogs & derivatives ; Stents ; Tubulin Modulators - administration & dosage</subject><ispartof>European heart journal, 2014-05, Vol.35 (17), p.1147-1158</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,1581,27911,27912</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24459196$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kang, Si-Hyuck</creatorcontrib><creatorcontrib>Park, Kyung Woo</creatorcontrib><creatorcontrib>Kang, Do-Yoon</creatorcontrib><creatorcontrib>Lim, Woo-Hyun</creatorcontrib><creatorcontrib>Park, Kyung Taek</creatorcontrib><creatorcontrib>Han, Jung-Kyu</creatorcontrib><creatorcontrib>Kang, Hyun-Jae</creatorcontrib><creatorcontrib>Koo, Bon-Kwon</creatorcontrib><creatorcontrib>Oh, Byung-Hee</creatorcontrib><creatorcontrib>Park, Young-Bae</creatorcontrib><creatorcontrib>Kandzari, David E.</creatorcontrib><creatorcontrib>Cohen, David J.</creatorcontrib><creatorcontrib>Hwang, Seung-Sik</creatorcontrib><creatorcontrib>Kim, Hyo-Soo</creatorcontrib><title>Biodegradable-polymer drug-eluting stents vs. bare metal stents vs. durable-polymer drug-eluting stents: a systematic review and Bayesian approach network meta-analysis</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>Background
The aim of this study was to compare the safety and efficacy of biodegradable-polymer (BP) drug-eluting stents (DES), bare metal stents (BMS), and durable-polymer DES in patients undergoing coronary revascularization, we performed a systematic review and network meta-analysis using a Bayesian framework.
Methods and results
Study stents included BMS, paclitaxel-eluting (PES), sirolimus-eluting (SES), endeavor zotarolimus-eluting (ZES-E), cobalt–chromium everolimus-eluting (CoCr-EES), platinium–chromium everolimus-eluting (PtCr-EES), resolute zotarolimus-eluting (ZES-R), and BP biolimus-eluting stents (BP-BES). After a systematic electronic search, 113 trials with 90 584 patients were selected. The principal endpoint was definite or probable stent thrombosis (ST) defined according to the Academic Research Consortium within 1 year.
Results
Biodegradable polymer-biolimus-eluting stents [OR, 0.56; 95% credible interval (CrI), 0.33–0.90], SES (OR, 0.53; 95% CrI, 0.38–0.73), CoCr-EES (OR, 0.34; 95% CrI, 0.23–0.52), and PtCr-EES (OR, 0.31; 95% CrI, 0.10–0.90) were all superior to BMS in terms of definite or probable ST within 1 year. Cobalt–chromium everolimus-eluting stents demonstrated the lowest risk of ST of all stents at all times after stent implantation. Biodegradable polymer-biolimus-eluting stents was associated with a higher risk of definite or probable ST than CoCr-EES (OR, 1.72; 95% CrI, 1.04–2.98). All DES reduced the need for repeat revascularization, and all but PES reduced the risk of myocardial infarction compared with BMS.
Conclusions
All DESs but PES and ZES-E were superior to BMS in terms of ST within 1 year. Cobalt–chromium everolimus-eluting stents was safer than any DES even including BP-BES. Our results suggest that not only the biodegradability of polymer, but the optimal combination of stent alloy, design, strut thickness, polymer, and drug all combined determine the safety of DES.</description><subject>Absorbable Implants</subject><subject>Bayes Theorem</subject><subject>Drug-Eluting Stents</subject><subject>Everolimus</subject><subject>Humans</subject><subject>Myocardial Infarction - therapy</subject><subject>Myocardial Revascularization - methods</subject><subject>Paclitaxel - administration & dosage</subject><subject>Prosthesis Failure</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Sirolimus - administration & dosage</subject><subject>Sirolimus - analogs & derivatives</subject><subject>Stents</subject><subject>Tubulin Modulators - administration & dosage</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkclOwzAQhi0EgrLcOSEfkVDAU8dOzA0Qm4TEpQdu0bSetIFs2E5R3ojHJNBSceM0o5lvFv0_Y8cgzkEYeUGdWxC68HpBi6ASscVGoMbjyOhYbbORAKMirdOXPbbv_asQItWgd9neOI6VAaNH7PO6aCzNHVqclhS1TdlX5Lh13TyisgtFPec-UB08X_pzPkVHvKKA5d-q7dx_05ccue-HvMJQzLijZUEfHGvLr7EnX2DNsW1dg7MFryl8NO7t506ENZa9L_wh28mx9HS0jgdscnc7uXmInp7vH2-unqIGkiREMwPSxtZqaabCQAKE1iBIIzBJQeaCcqXyMaQWrAIhcmWUtjZJjIFBOnnATldrh1_eO_Ihqwo_o7LEmprOZwMDUmoVpwN6ska7aUU2a11RoeuzX3EH4GwFNF276YLIvq3LNtZlK-vkF_wlkS0</recordid><startdate>20140501</startdate><enddate>20140501</enddate><creator>Kang, Si-Hyuck</creator><creator>Park, Kyung Woo</creator><creator>Kang, Do-Yoon</creator><creator>Lim, Woo-Hyun</creator><creator>Park, Kyung Taek</creator><creator>Han, Jung-Kyu</creator><creator>Kang, Hyun-Jae</creator><creator>Koo, Bon-Kwon</creator><creator>Oh, Byung-Hee</creator><creator>Park, Young-Bae</creator><creator>Kandzari, David E.</creator><creator>Cohen, David J.</creator><creator>Hwang, Seung-Sik</creator><creator>Kim, Hyo-Soo</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>20140501</creationdate><title>Biodegradable-polymer drug-eluting stents vs. bare metal stents vs. durable-polymer drug-eluting stents: a systematic review and Bayesian approach network meta-analysis</title><author>Kang, Si-Hyuck ; Park, Kyung Woo ; Kang, Do-Yoon ; Lim, Woo-Hyun ; Park, Kyung Taek ; Han, Jung-Kyu ; Kang, Hyun-Jae ; Koo, Bon-Kwon ; Oh, Byung-Hee ; Park, Young-Bae ; Kandzari, David E. ; Cohen, David J. ; Hwang, Seung-Sik ; Kim, Hyo-Soo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-o177t-c913d4dd639b09171ead9a1390a7813f0ef55f218d1d5100f5956dd779911523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Absorbable Implants</topic><topic>Bayes Theorem</topic><topic>Drug-Eluting Stents</topic><topic>Everolimus</topic><topic>Humans</topic><topic>Myocardial Infarction - therapy</topic><topic>Myocardial Revascularization - methods</topic><topic>Paclitaxel - administration & dosage</topic><topic>Prosthesis Failure</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Sirolimus - administration & dosage</topic><topic>Sirolimus - analogs & derivatives</topic><topic>Stents</topic><topic>Tubulin Modulators - administration & dosage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kang, Si-Hyuck</creatorcontrib><creatorcontrib>Park, Kyung Woo</creatorcontrib><creatorcontrib>Kang, Do-Yoon</creatorcontrib><creatorcontrib>Lim, Woo-Hyun</creatorcontrib><creatorcontrib>Park, Kyung Taek</creatorcontrib><creatorcontrib>Han, Jung-Kyu</creatorcontrib><creatorcontrib>Kang, Hyun-Jae</creatorcontrib><creatorcontrib>Koo, Bon-Kwon</creatorcontrib><creatorcontrib>Oh, Byung-Hee</creatorcontrib><creatorcontrib>Park, Young-Bae</creatorcontrib><creatorcontrib>Kandzari, David E.</creatorcontrib><creatorcontrib>Cohen, David J.</creatorcontrib><creatorcontrib>Hwang, Seung-Sik</creatorcontrib><creatorcontrib>Kim, Hyo-Soo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kang, Si-Hyuck</au><au>Park, Kyung Woo</au><au>Kang, Do-Yoon</au><au>Lim, Woo-Hyun</au><au>Park, Kyung Taek</au><au>Han, Jung-Kyu</au><au>Kang, Hyun-Jae</au><au>Koo, Bon-Kwon</au><au>Oh, Byung-Hee</au><au>Park, Young-Bae</au><au>Kandzari, David E.</au><au>Cohen, David J.</au><au>Hwang, Seung-Sik</au><au>Kim, Hyo-Soo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Biodegradable-polymer drug-eluting stents vs. bare metal stents vs. durable-polymer drug-eluting stents: a systematic review and Bayesian approach network meta-analysis</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2014-05-01</date><risdate>2014</risdate><volume>35</volume><issue>17</issue><spage>1147</spage><epage>1158</epage><pages>1147-1158</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Background
The aim of this study was to compare the safety and efficacy of biodegradable-polymer (BP) drug-eluting stents (DES), bare metal stents (BMS), and durable-polymer DES in patients undergoing coronary revascularization, we performed a systematic review and network meta-analysis using a Bayesian framework.
Methods and results
Study stents included BMS, paclitaxel-eluting (PES), sirolimus-eluting (SES), endeavor zotarolimus-eluting (ZES-E), cobalt–chromium everolimus-eluting (CoCr-EES), platinium–chromium everolimus-eluting (PtCr-EES), resolute zotarolimus-eluting (ZES-R), and BP biolimus-eluting stents (BP-BES). After a systematic electronic search, 113 trials with 90 584 patients were selected. The principal endpoint was definite or probable stent thrombosis (ST) defined according to the Academic Research Consortium within 1 year.
Results
Biodegradable polymer-biolimus-eluting stents [OR, 0.56; 95% credible interval (CrI), 0.33–0.90], SES (OR, 0.53; 95% CrI, 0.38–0.73), CoCr-EES (OR, 0.34; 95% CrI, 0.23–0.52), and PtCr-EES (OR, 0.31; 95% CrI, 0.10–0.90) were all superior to BMS in terms of definite or probable ST within 1 year. Cobalt–chromium everolimus-eluting stents demonstrated the lowest risk of ST of all stents at all times after stent implantation. Biodegradable polymer-biolimus-eluting stents was associated with a higher risk of definite or probable ST than CoCr-EES (OR, 1.72; 95% CrI, 1.04–2.98). All DES reduced the need for repeat revascularization, and all but PES reduced the risk of myocardial infarction compared with BMS.
Conclusions
All DESs but PES and ZES-E were superior to BMS in terms of ST within 1 year. Cobalt–chromium everolimus-eluting stents was safer than any DES even including BP-BES. Our results suggest that not only the biodegradability of polymer, but the optimal combination of stent alloy, design, strut thickness, polymer, and drug all combined determine the safety of DES.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>24459196</pmid><doi>10.1093/eurheartj/eht570</doi><tpages>12</tpages></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Absorbable Implants Bayes Theorem Drug-Eluting Stents Everolimus Humans Myocardial Infarction - therapy Myocardial Revascularization - methods Paclitaxel - administration & dosage Prosthesis Failure Randomized Controlled Trials as Topic Sirolimus - administration & dosage Sirolimus - analogs & derivatives Stents Tubulin Modulators - administration & dosage |
| title | Biodegradable-polymer drug-eluting stents vs. bare metal stents vs. durable-polymer drug-eluting stents: a systematic review and Bayesian approach network meta-analysis |
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