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Meta-analysis of drug eluting stents compared with bare metal stents in high bleeding risk patients undergoing

Saroj Neupane1, Owais Khawaja2, Sushruth Edla2

  • 1Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|December 27, 2018
PubMed

Insights

Drug-eluting stents (DES) are effective for high bleeding risk (HBR) patients, showing lower major adverse cardiovascular events (MACE) than bare metal stents (BMS). DES use with short dual antiplatelet therapy (DAPT) did not increase bleeding or stent thrombosis risks.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Biomaterials Science

Background:

  • Drug-eluting stents (DES) reduce target lesion revascularization (TLR) and stent thrombosis (ST) compared to bare metal stents (BMS) after percutaneous coronary intervention (PCI).
  • High bleeding risk (HBR) patients often receive BMS due to concerns about bleeding or ST from premature dual antiplatelet therapy (DAPT) discontinuation with DES.

Purpose of the Study:

  • To evaluate the efficacy and safety of DES versus BMS with short or tailored DAPT in HBR patients.
  • To compare rates of major adverse cardiovascular events (MACE), bleeding, and stent thrombosis between DES and BMS in HBR patients.

Main Methods:

  • Meta-analysis of randomized controlled trials (RCTs) comparing DES with BMS in HBR patients.
  • Systematic literature search of PubMed, MEDLINE, and Cochrane Central up to March 1, 2018.
  • Inclusion of three RCTs with a total of 4,460 patients.

Main Results:

  • DES use was associated with significantly lower MACE (composite of death, myocardial infarction, and TLR) at 1 year compared to BMS (RR=0.63, 95% CI 0.50-0.80).
  • The reduction in MACE was primarily driven by a significant decrease in TLR (RR=0.46, 95% CI 0.35-0.61) with DES.
  • Rates of definite/probable ST (RR=0.59, 95% CI 0.32-1.08) and major bleeding (RR=0.94, 95% CI 0.74-1.20) were similar between DES and BMS groups.

Conclusions:

  • DES are associated with reduced MACE in HBR patients when used with short or tailored DAPT.
  • DES do not increase the risk of bleeding or stent thrombosis compared to BMS in this population.
  • These findings support the use of DES in HBR patients, challenging previous concerns regarding bleeding and DAPT duration.
Abstract

Keywords:
bare metal stentdrug-eluting stentdual antiplatelet therapyhigh bleeding riskpercutaneous coronary interventionstent thrombosis

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