Safety and Efficacy of Different Stent Strategies in Percutaneous Coronary Intervention: A Network Meta-Analysis

The utility of polymer-permanent, polymer-absorbable, and polymer-free drug-eluting stents (DES) in the context of different eluting drugs in patients undergoing percutaneous coronary intervention (PCI) remains controversial.

The purpose of this study was to compare the efficacy of different DES strategies in post-PCI patients.

Digital databases were searched to select all randomized control trials. Different combinations of DES were directly compared with permanent-polymer sirolimus-eluting stents. The primary outcome was major adverse cardiovascular events; a composite of cardiovascular mortality, myocardial infarction (MI), and target vessel revascularization. A network meta-analysis was performed to determine the net relative risk (RR) and its 95% CI.

A total of 314 randomized control trials comprising 345,749 patients with coronary artery disease undergoing PCI were included. Compared with polymer-permanent sirolimus-eluting stent, polymer-free titanium-nitride-oxide (RR: 0.68; 95% CI: 0.53-0.87), polymer-permanent everolimus (RR: 0.89; 95% CI: 0.82-0.96), and zotarolimus stents (RR: 0.89; 95% CI: 0.79-0.99) had a lower risk of major adverse cardiovascular events at 5 years. Polymer-free titanium-nitride-oxide stents also had a significantly lower incidence of stent thrombosis (RR: 0.28; 95% CI: 0.13-0.59) and MI (RR: 0.41; 95% CI: 0.27-0.62) at 1 year. Bare metal stents had a significantly higher 1-year risk of MI (RR: 1.52; 95% CI: 1.25-1.86), and need for target vessel revascularization (RR: 2.26; 95% CI: 1.93-2.64).

In comparison with polymer-permanent sirolimus, the newer stents including polymer-free titanium-nitride-oxide, polymer-permanent everolimus, and zotarolimus stents significantly reduce the risk of long-term ischemic events.