Bare metal stents, durable polymer drug eluting stents, and biodegradable polymer drug eluting stents for coronary artery disease: mixed treatment comparison meta-analysis
Objective To compare the efficacy and safety of biodegradable polymer drug eluting stents with those of bare metal stents and durable polymer drug eluting stents.Design Mixed treatment comparison meta-analysis of 258 544 patient years of follow-up from randomized trials.Data sources and study select...
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| Veröffentlicht in: | BMJ (Online) 2013-11, Vol.347 (nov08 1), p.f6625-f6625 |
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| creator | Bangalore, Sripal Toklu, Bora Amoroso, Nicholas Fusaro, Mario Kumar, Sunil Hannan, Edward L Faxon, David P Feit, Frederick |
| description | Objective To compare the efficacy and safety of biodegradable polymer drug eluting stents with those of bare metal stents and durable polymer drug eluting stents.Design Mixed treatment comparison meta-analysis of 258 544 patient years of follow-up from randomized trials.Data sources and study selection PubMed, Embase, and Central were searched for randomized trials comparing any of the Food and Drug Administration approved durable polymer drug eluting stents (sirolimus eluting, paclitaxel eluting, cobalt chromium everolimus eluting, platinum chromium everolimus eluting, zotarolimus eluting-Endeavor, and zotarolimus eluting-Resolute) or biodegradable polymer drug eluting stents, with each other or against bare metal stents.Outcomes Long term efficacy (target vessel revascularization, target lesion revascularization) and safety (death, myocardial infarction, stent thrombosis). Landmark analysis at more than one year was evaluated to assess the potential late benefit of biodegradable polymer drug eluting stents.Results From 126 randomized trials and 258 544 patient years of follow-up, for long term efficacy (target vessel revascularization), biodegradable polymer drug eluting stents were superior to paclitaxel eluting stents (rate ratio 0.66, 95% credibility interval 0.57 to 0.78) and zotarolimus eluting stent-Endeavor (0.69, 0.56 to 0.84) but not to newer generation durable polymer drug eluting stents (for example: 1.03, 0.89 to 1.21 versus cobalt chromium everolimus eluting stents). Similarly, biodegradable polymer drug eluting stents were superior to paclitaxel eluting stents (rate ratio 0.61, 0.37 to 0.89) but inferior to cobalt chromium everolimus eluting stents (2.04, 1.27 to 3.35) for long term safety (definite stent thrombosis). In the landmark analysis after one year, biodegradable polymer drug eluting stents were superior to sirolimus eluting stents for definite stent thrombosis (rate ratio 0.29, 0.10 to 0.82) but were associated with increased mortality compared with cobalt chromium everolimus eluting stents (1.52, 1.02 to 2.22). Overall, among all stent types, the newer generation durable polymer drug eluting stents (zotarolimus eluting stent-Resolute, cobalt chromium everolimus eluting stents, and platinum chromium everolimus eluting stents) were the most efficacious (lowest target vessel revascularization rate) stents, and cobalt chromium everolimus eluting stents were the safest with significant reductions in definite stent thrombosis (rate rat |
| doi_str_mv | 10.1136/bmj.f6625 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3898413</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1458184906</sourcerecordid><originalsourceid>FETCH-LOGICAL-b470t-5b360a8ad96a5ee9ea8154c2890752e69727d464e2c2978ecfac9b86dca6df173</originalsourceid><addsrcrecordid>eNqF0s1u1DAQB_AIUdFV2wMvgCzBASRSbCf-6gEJVpQiVcABuFqTeLJ4SeLFTlD3mXhJ3G5ZFSTEyYf5aeZvzRTFQ0ZPGavki2ZYn3ZScnGvWDAlZMl0Vd0vFtQIU2pW6cPiJKU1pZRXShspHhSHvOaMM6oWxc_XEJEMOEFP0oTjlJ4TN0doeiSb0G8HjMTFeUWwnyc_rvYIRkcaHxyuIrj_cdKFSNoQwwhxSyBOmB_nE0LCMzL4K3RkigjTkHWGwwaiT2G8CVbCCP02-XRcHHTQJzy5fY-Kz-dvPi0vyssPb98tX12WTa3oVIqmkhQ0OCNBIBoEzUTdcm2oEhylUVy5WtbIW26UxraD1jRauhak65iqjoqXu76buRnQtTlThN5uoh9yfBvA2z8ro_9qV-GHrbTRNatyg6e3DWL4PmOa7OBTi30PI4Y5WVYLzXRtqMz08V90HeaYP5yVyUwbQXVWz3aqjSGliN0-DKP2-gpsvgJ7cwXZPrqbfi9_7zyDcgd8Xs7Vvg7xm5WqUsK-_7K0Hzk7N2opbZ39k52_nvHvub8AVlrNcA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1945889508</pqid></control><display><type>article</type><title>Bare metal stents, durable polymer drug eluting stents, and biodegradable polymer drug eluting stents for coronary artery disease: mixed treatment comparison meta-analysis</title><source>BMJ Journals Online Archive</source><source>MEDLINE</source><source>JSTOR</source><creator>Bangalore, Sripal ; Toklu, Bora ; Amoroso, Nicholas ; Fusaro, Mario ; Kumar, Sunil ; Hannan, Edward L ; Faxon, David P ; Feit, Frederick</creator><creatorcontrib>Bangalore, Sripal ; Toklu, Bora ; Amoroso, Nicholas ; Fusaro, Mario ; Kumar, Sunil ; Hannan, Edward L ; Faxon, David P ; Feit, Frederick</creatorcontrib><description>Objective To compare the efficacy and safety of biodegradable polymer drug eluting stents with those of bare metal stents and durable polymer drug eluting stents.Design Mixed treatment comparison meta-analysis of 258 544 patient years of follow-up from randomized trials.Data sources and study selection PubMed, Embase, and Central were searched for randomized trials comparing any of the Food and Drug Administration approved durable polymer drug eluting stents (sirolimus eluting, paclitaxel eluting, cobalt chromium everolimus eluting, platinum chromium everolimus eluting, zotarolimus eluting-Endeavor, and zotarolimus eluting-Resolute) or biodegradable polymer drug eluting stents, with each other or against bare metal stents.Outcomes Long term efficacy (target vessel revascularization, target lesion revascularization) and safety (death, myocardial infarction, stent thrombosis). Landmark analysis at more than one year was evaluated to assess the potential late benefit of biodegradable polymer drug eluting stents.Results From 126 randomized trials and 258 544 patient years of follow-up, for long term efficacy (target vessel revascularization), biodegradable polymer drug eluting stents were superior to paclitaxel eluting stents (rate ratio 0.66, 95% credibility interval 0.57 to 0.78) and zotarolimus eluting stent-Endeavor (0.69, 0.56 to 0.84) but not to newer generation durable polymer drug eluting stents (for example: 1.03, 0.89 to 1.21 versus cobalt chromium everolimus eluting stents). Similarly, biodegradable polymer drug eluting stents were superior to paclitaxel eluting stents (rate ratio 0.61, 0.37 to 0.89) but inferior to cobalt chromium everolimus eluting stents (2.04, 1.27 to 3.35) for long term safety (definite stent thrombosis). In the landmark analysis after one year, biodegradable polymer drug eluting stents were superior to sirolimus eluting stents for definite stent thrombosis (rate ratio 0.29, 0.10 to 0.82) but were associated with increased mortality compared with cobalt chromium everolimus eluting stents (1.52, 1.02 to 2.22). Overall, among all stent types, the newer generation durable polymer drug eluting stents (zotarolimus eluting stent-Resolute, cobalt chromium everolimus eluting stents, and platinum chromium everolimus eluting stents) were the most efficacious (lowest target vessel revascularization rate) stents, and cobalt chromium everolimus eluting stents were the safest with significant reductions in definite stent thrombosis (rate ratio 0.35, 0.21 to 0.53), myocardial infarction (0.65, 0.55 to 0.75), and death (0.72, 0.58 to 0.90) compared with bare metal stents.Conclusions Biodegradable polymer drug eluting stents are superior to first generation durable polymer drug eluting stents but not to newer generation durable polymer stents in reducing target vessel revascularization. Newer generation durable polymer stents, and especially cobalt chromium everolimus eluting stents, have the best combination of efficacy and safety. The utility of biodegradable polymer stents in the context of excellent clinical outcomes with newer generation durable polymer stents needs to be proven.</description><identifier>ISSN: 0959-8138</identifier><identifier>ISSN: 1756-1833</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.f6625</identifier><identifier>PMID: 24212107</identifier><language>eng</language><publisher>England: British Medical Journal Publishing Group</publisher><subject>Angioplasty ; Anti-Infective Agents - therapeutic use ; Bias ; Biodegradability ; Biodegradable materials ; Cardiology ; Cardiovascular disease ; Chromium ; Clinical trials ; Cobalt ; Coronary artery ; Coronary Artery Disease - surgery ; Coronary Artery Disease - therapy ; Coronary vessels ; Drug delivery ; Drug development ; Drug-Eluting Stents ; Everolimus ; FDA approval ; Female ; Follow-Up Studies ; Heart attacks ; Heart diseases ; Humans ; Immunosuppressive Agents - therapeutic use ; Implants ; Male ; Medical imaging ; Meta-analysis ; Myocardial infarction ; Myocardial Infarction - drug therapy ; Paclitaxel ; Paclitaxel - therapeutic use ; Patients ; Platinum ; Polymers ; Randomized Controlled Trials as Topic ; Rapamycin ; Sirolimus - analogs & derivatives ; Sirolimus - therapeutic use ; Stents ; Thrombosis ; Treatment Outcome</subject><ispartof>BMJ (Online), 2013-11, Vol.347 (nov08 1), p.f6625-f6625</ispartof><rights>Bangalore et al 2013</rights><rights>Copyright: 2013 © Bangalore et al 2013</rights><rights>Bangalore et al 2013 2013 Bangalore et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b470t-5b360a8ad96a5ee9ea8154c2890752e69727d464e2c2978ecfac9b86dca6df173</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bmj.com/content/347/bmj.f6625.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttp://bmj.com/content/347/bmj.f6625.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>114,115,230,314,780,784,885,3196,23571,27924,27925,77600,77631</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24212107$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bangalore, Sripal</creatorcontrib><creatorcontrib>Toklu, Bora</creatorcontrib><creatorcontrib>Amoroso, Nicholas</creatorcontrib><creatorcontrib>Fusaro, Mario</creatorcontrib><creatorcontrib>Kumar, Sunil</creatorcontrib><creatorcontrib>Hannan, Edward L</creatorcontrib><creatorcontrib>Faxon, David P</creatorcontrib><creatorcontrib>Feit, Frederick</creatorcontrib><title>Bare metal stents, durable polymer drug eluting stents, and biodegradable polymer drug eluting stents for coronary artery disease: mixed treatment comparison meta-analysis</title><title>BMJ (Online)</title><addtitle>BMJ</addtitle><description>Objective To compare the efficacy and safety of biodegradable polymer drug eluting stents with those of bare metal stents and durable polymer drug eluting stents.Design Mixed treatment comparison meta-analysis of 258 544 patient years of follow-up from randomized trials.Data sources and study selection PubMed, Embase, and Central were searched for randomized trials comparing any of the Food and Drug Administration approved durable polymer drug eluting stents (sirolimus eluting, paclitaxel eluting, cobalt chromium everolimus eluting, platinum chromium everolimus eluting, zotarolimus eluting-Endeavor, and zotarolimus eluting-Resolute) or biodegradable polymer drug eluting stents, with each other or against bare metal stents.Outcomes Long term efficacy (target vessel revascularization, target lesion revascularization) and safety (death, myocardial infarction, stent thrombosis). Landmark analysis at more than one year was evaluated to assess the potential late benefit of biodegradable polymer drug eluting stents.Results From 126 randomized trials and 258 544 patient years of follow-up, for long term efficacy (target vessel revascularization), biodegradable polymer drug eluting stents were superior to paclitaxel eluting stents (rate ratio 0.66, 95% credibility interval 0.57 to 0.78) and zotarolimus eluting stent-Endeavor (0.69, 0.56 to 0.84) but not to newer generation durable polymer drug eluting stents (for example: 1.03, 0.89 to 1.21 versus cobalt chromium everolimus eluting stents). Similarly, biodegradable polymer drug eluting stents were superior to paclitaxel eluting stents (rate ratio 0.61, 0.37 to 0.89) but inferior to cobalt chromium everolimus eluting stents (2.04, 1.27 to 3.35) for long term safety (definite stent thrombosis). In the landmark analysis after one year, biodegradable polymer drug eluting stents were superior to sirolimus eluting stents for definite stent thrombosis (rate ratio 0.29, 0.10 to 0.82) but were associated with increased mortality compared with cobalt chromium everolimus eluting stents (1.52, 1.02 to 2.22). Overall, among all stent types, the newer generation durable polymer drug eluting stents (zotarolimus eluting stent-Resolute, cobalt chromium everolimus eluting stents, and platinum chromium everolimus eluting stents) were the most efficacious (lowest target vessel revascularization rate) stents, and cobalt chromium everolimus eluting stents were the safest with significant reductions in definite stent thrombosis (rate ratio 0.35, 0.21 to 0.53), myocardial infarction (0.65, 0.55 to 0.75), and death (0.72, 0.58 to 0.90) compared with bare metal stents.Conclusions Biodegradable polymer drug eluting stents are superior to first generation durable polymer drug eluting stents but not to newer generation durable polymer stents in reducing target vessel revascularization. Newer generation durable polymer stents, and especially cobalt chromium everolimus eluting stents, have the best combination of efficacy and safety. The utility of biodegradable polymer stents in the context of excellent clinical outcomes with newer generation durable polymer stents needs to be proven.</description><subject>Angioplasty</subject><subject>Anti-Infective Agents - therapeutic use</subject><subject>Bias</subject><subject>Biodegradability</subject><subject>Biodegradable materials</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Chromium</subject><subject>Clinical trials</subject><subject>Cobalt</subject><subject>Coronary artery</subject><subject>Coronary Artery Disease - surgery</subject><subject>Coronary Artery Disease - therapy</subject><subject>Coronary vessels</subject><subject>Drug delivery</subject><subject>Drug development</subject><subject>Drug-Eluting Stents</subject><subject>Everolimus</subject><subject>FDA approval</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart attacks</subject><subject>Heart diseases</subject><subject>Humans</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Implants</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Meta-analysis</subject><subject>Myocardial infarction</subject><subject>Myocardial Infarction - drug therapy</subject><subject>Paclitaxel</subject><subject>Paclitaxel - therapeutic use</subject><subject>Patients</subject><subject>Platinum</subject><subject>Polymers</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Rapamycin</subject><subject>Sirolimus - analogs & derivatives</subject><subject>Sirolimus - therapeutic use</subject><subject>Stents</subject><subject>Thrombosis</subject><subject>Treatment Outcome</subject><issn>0959-8138</issn><issn>1756-1833</issn><issn>1756-1833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqF0s1u1DAQB_AIUdFV2wMvgCzBASRSbCf-6gEJVpQiVcABuFqTeLJ4SeLFTlD3mXhJ3G5ZFSTEyYf5aeZvzRTFQ0ZPGavki2ZYn3ZScnGvWDAlZMl0Vd0vFtQIU2pW6cPiJKU1pZRXShspHhSHvOaMM6oWxc_XEJEMOEFP0oTjlJ4TN0doeiSb0G8HjMTFeUWwnyc_rvYIRkcaHxyuIrj_cdKFSNoQwwhxSyBOmB_nE0LCMzL4K3RkigjTkHWGwwaiT2G8CVbCCP02-XRcHHTQJzy5fY-Kz-dvPi0vyssPb98tX12WTa3oVIqmkhQ0OCNBIBoEzUTdcm2oEhylUVy5WtbIW26UxraD1jRauhak65iqjoqXu76buRnQtTlThN5uoh9yfBvA2z8ro_9qV-GHrbTRNatyg6e3DWL4PmOa7OBTi30PI4Y5WVYLzXRtqMz08V90HeaYP5yVyUwbQXVWz3aqjSGliN0-DKP2-gpsvgJ7cwXZPrqbfi9_7zyDcgd8Xs7Vvg7xm5WqUsK-_7K0Hzk7N2opbZ39k52_nvHvub8AVlrNcA</recordid><startdate>20131108</startdate><enddate>20131108</enddate><creator>Bangalore, Sripal</creator><creator>Toklu, Bora</creator><creator>Amoroso, Nicholas</creator><creator>Fusaro, Mario</creator><creator>Kumar, Sunil</creator><creator>Hannan, Edward L</creator><creator>Faxon, David P</creator><creator>Feit, Frederick</creator><general>British Medical Journal Publishing Group</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group Ltd</general><scope>9YT</scope><scope>ACMMV</scope><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20131108</creationdate><title>Bare metal stents, durable polymer drug eluting stents, and biodegradable polymer drug eluting stents for coronary artery disease: mixed treatment comparison meta-analysis</title><author>Bangalore, Sripal ; Toklu, Bora ; Amoroso, Nicholas ; Fusaro, Mario ; Kumar, Sunil ; Hannan, Edward L ; Faxon, David P ; Feit, Frederick</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b470t-5b360a8ad96a5ee9ea8154c2890752e69727d464e2c2978ecfac9b86dca6df173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Angioplasty</topic><topic>Anti-Infective Agents - therapeutic use</topic><topic>Bias</topic><topic>Biodegradability</topic><topic>Biodegradable materials</topic><topic>Cardiology</topic><topic>Cardiovascular disease</topic><topic>Chromium</topic><topic>Clinical trials</topic><topic>Cobalt</topic><topic>Coronary artery</topic><topic>Coronary Artery Disease - surgery</topic><topic>Coronary Artery Disease - therapy</topic><topic>Coronary vessels</topic><topic>Drug delivery</topic><topic>Drug development</topic><topic>Drug-Eluting Stents</topic><topic>Everolimus</topic><topic>FDA approval</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart attacks</topic><topic>Heart diseases</topic><topic>Humans</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Implants</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Meta-analysis</topic><topic>Myocardial infarction</topic><topic>Myocardial Infarction - drug therapy</topic><topic>Paclitaxel</topic><topic>Paclitaxel - therapeutic use</topic><topic>Patients</topic><topic>Platinum</topic><topic>Polymers</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Rapamycin</topic><topic>Sirolimus - analogs & derivatives</topic><topic>Sirolimus - therapeutic use</topic><topic>Stents</topic><topic>Thrombosis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bangalore, Sripal</creatorcontrib><creatorcontrib>Toklu, Bora</creatorcontrib><creatorcontrib>Amoroso, Nicholas</creatorcontrib><creatorcontrib>Fusaro, Mario</creatorcontrib><creatorcontrib>Kumar, Sunil</creatorcontrib><creatorcontrib>Hannan, Edward L</creatorcontrib><creatorcontrib>Faxon, David P</creatorcontrib><creatorcontrib>Feit, Frederick</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Proquest Health & Medical Complete</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>ProQuest_Research Library</collection><collection>ProQuest Science Journals</collection><collection>ProQuest Biological Science Journals</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ (Online)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bangalore, Sripal</au><au>Toklu, Bora</au><au>Amoroso, Nicholas</au><au>Fusaro, Mario</au><au>Kumar, Sunil</au><au>Hannan, Edward L</au><au>Faxon, David P</au><au>Feit, Frederick</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bare metal stents, durable polymer drug eluting stents, and biodegradable polymer drug eluting stents for coronary artery disease: mixed treatment comparison meta-analysis</atitle><jtitle>BMJ (Online)</jtitle><addtitle>BMJ</addtitle><date>2013-11-08</date><risdate>2013</risdate><volume>347</volume><issue>nov08 1</issue><spage>f6625</spage><epage>f6625</epage><pages>f6625-f6625</pages><issn>0959-8138</issn><issn>1756-1833</issn><eissn>1756-1833</eissn><abstract>Objective To compare the efficacy and safety of biodegradable polymer drug eluting stents with those of bare metal stents and durable polymer drug eluting stents.Design Mixed treatment comparison meta-analysis of 258 544 patient years of follow-up from randomized trials.Data sources and study selection PubMed, Embase, and Central were searched for randomized trials comparing any of the Food and Drug Administration approved durable polymer drug eluting stents (sirolimus eluting, paclitaxel eluting, cobalt chromium everolimus eluting, platinum chromium everolimus eluting, zotarolimus eluting-Endeavor, and zotarolimus eluting-Resolute) or biodegradable polymer drug eluting stents, with each other or against bare metal stents.Outcomes Long term efficacy (target vessel revascularization, target lesion revascularization) and safety (death, myocardial infarction, stent thrombosis). Landmark analysis at more than one year was evaluated to assess the potential late benefit of biodegradable polymer drug eluting stents.Results From 126 randomized trials and 258 544 patient years of follow-up, for long term efficacy (target vessel revascularization), biodegradable polymer drug eluting stents were superior to paclitaxel eluting stents (rate ratio 0.66, 95% credibility interval 0.57 to 0.78) and zotarolimus eluting stent-Endeavor (0.69, 0.56 to 0.84) but not to newer generation durable polymer drug eluting stents (for example: 1.03, 0.89 to 1.21 versus cobalt chromium everolimus eluting stents). Similarly, biodegradable polymer drug eluting stents were superior to paclitaxel eluting stents (rate ratio 0.61, 0.37 to 0.89) but inferior to cobalt chromium everolimus eluting stents (2.04, 1.27 to 3.35) for long term safety (definite stent thrombosis). In the landmark analysis after one year, biodegradable polymer drug eluting stents were superior to sirolimus eluting stents for definite stent thrombosis (rate ratio 0.29, 0.10 to 0.82) but were associated with increased mortality compared with cobalt chromium everolimus eluting stents (1.52, 1.02 to 2.22). Overall, among all stent types, the newer generation durable polymer drug eluting stents (zotarolimus eluting stent-Resolute, cobalt chromium everolimus eluting stents, and platinum chromium everolimus eluting stents) were the most efficacious (lowest target vessel revascularization rate) stents, and cobalt chromium everolimus eluting stents were the safest with significant reductions in definite stent thrombosis (rate ratio 0.35, 0.21 to 0.53), myocardial infarction (0.65, 0.55 to 0.75), and death (0.72, 0.58 to 0.90) compared with bare metal stents.Conclusions Biodegradable polymer drug eluting stents are superior to first generation durable polymer drug eluting stents but not to newer generation durable polymer stents in reducing target vessel revascularization. Newer generation durable polymer stents, and especially cobalt chromium everolimus eluting stents, have the best combination of efficacy and safety. The utility of biodegradable polymer stents in the context of excellent clinical outcomes with newer generation durable polymer stents needs to be proven.</abstract><cop>England</cop><pub>British Medical Journal Publishing Group</pub><pmid>24212107</pmid><doi>10.1136/bmj.f6625</doi><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0959-8138 |
| ispartof | BMJ (Online), 2013-11, Vol.347 (nov08 1), p.f6625-f6625 |
| issn | 0959-8138 1756-1833 1756-1833 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3898413 |
| source | BMJ Journals Online Archive; MEDLINE; JSTOR |
| subjects | Angioplasty Anti-Infective Agents - therapeutic use Bias Biodegradability Biodegradable materials Cardiology Cardiovascular disease Chromium Clinical trials Cobalt Coronary artery Coronary Artery Disease - surgery Coronary Artery Disease - therapy Coronary vessels Drug delivery Drug development Drug-Eluting Stents Everolimus FDA approval Female Follow-Up Studies Heart attacks Heart diseases Humans Immunosuppressive Agents - therapeutic use Implants Male Medical imaging Meta-analysis Myocardial infarction Myocardial Infarction - drug therapy Paclitaxel Paclitaxel - therapeutic use Patients Platinum Polymers Randomized Controlled Trials as Topic Rapamycin Sirolimus - analogs & derivatives Sirolimus - therapeutic use Stents Thrombosis Treatment Outcome |
| title | Bare metal stents, durable polymer drug eluting stents, and biodegradable polymer drug eluting stents for coronary artery disease: mixed treatment comparison meta-analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-25T07%3A10%3A49IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Bare%20metal%20stents,%20durable%20polymer%20drug%20eluting%20stents,%20and%20biodegradable%20polymer%20drug%20eluting%20stents%20for%20coronary%20artery%20disease:%20mixed%20treatment%20comparison%20meta-analysis&rft.jtitle=BMJ%20(Online)&rft.au=Bangalore,%20Sripal&rft.date=2013-11-08&rft.volume=347&rft.issue=nov08%201&rft.spage=f6625&rft.epage=f6625&rft.pages=f6625-f6625&rft.issn=0959-8138&rft.eissn=1756-1833&rft_id=info:doi/10.1136/bmj.f6625&rft_dat=%3Cproquest_pubme%3E1458184906%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1945889508&rft_id=info:pmid/24212107&rfr_iscdi=true |