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Bare-metal stent versus drug-eluting stent in large coronary arteries: meta-analysis of randomized controlled trials

Deng-Feng Geng1, Zhe Meng, Hai-Yan Yan

  • 1Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, 510120, China.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|August 18, 2012
PubMed

Insights

Drug-eluting stents (DES) show superiority over bare-metal stents (BMS) in reducing adverse cardiac events in large coronary arteries during mid-term follow-up. Long-term efficacy requires further study.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Efficacy of drug-eluting stents (DES) versus bare-metal stents (BMS) in large coronary arteries remains uncertain.
  • Large coronary arteries present unique challenges for stent implantation and outcomes.

Purpose of the Study:

  • To compare the clinical efficacy of DES versus BMS in large coronary vessels (≥3.0 mm).
  • To conduct a meta-analysis of randomized controlled trials (RCTs) evaluating DES vs. BMS in this patient population.

Main Methods:

  • Meta-analysis of six relevant randomized controlled trials (RCTs).
  • Inclusion of 4,399 patients with large coronary arteries (reference vessel diameter ≥3.0 mm).
  • Assessment of clinical events including cardiac death, myocardial infarction, stent thrombosis, and target vessel revascularization (TVR).

Main Results:

  • No significant differences in cardiac death/MI, cardiac death, myocardial infarction, or stent thrombosis between DES and BMS.
  • DES significantly reduced the risk of target vessel revascularization (TVR) compared to BMS [Hazard Ratio: 0.48 (0.33, 0.70)].
  • Benefits of DES for TVR were consistent across various patient subgroups and stent generations, with no significant differences at ≥3-year follow-up.

Conclusions:

  • Drug-eluting stents (DES) demonstrate superior mid-term efficacy over bare-metal stents (BMS) in reducing adverse cardiac events in large coronary arteries.
  • Further research is warranted to evaluate the long-term efficacy of newer-generation DES compared to BMS in larger coronary arteries.
Abstract

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