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Meta-Analysis
. 2021 Jul 15;42(27):2643-2654.
doi: 10.1093/eurheartj/ehab280.

Long-term follow-up after ultrathin vs. conventional 2nd-generation drug-eluting stents: a systematic review and meta-analysis of randomized controlled trials

Mahesh V Madhavan  1   2 , James P Howard  3 , Azim Naqvi  2 , Ori Ben-Yehuda  2 , Bjorn Redfors  2   4 , Megha Prasad  1 , Bahira Shahim  2 , Martin B Leon  1   2 , Sripal Bangalore  5 , Gregg W Stone  2   6 , Yousif Ahmad  7
Affiliations
Meta-Analysis

Long-term follow-up after ultrathin vs. conventional 2nd-generation drug-eluting stents: a systematic review and meta-analysis of randomized controlled trials

Mahesh V Madhavan et al. Eur Heart J. .

Abstract

Aims: Contemporary 2nd-generation thin-strut drug-eluting stents (DES) are considered standard of care for revascularization of patients undergoing percutaneous coronary intervention. A previous meta-analysis of 10 randomized controlled trials (RCTs) with 11 658 patients demonstrated a 16% reduction in the 1-year risk of target lesion failure (TLF) with ultrathin-strut DES compared with conventional 2nd-generation thin-strut DES. Whether this benefit is sustained longer term is not known, and newer trial data may inform these relative outcomes. We therefore sought to perform an updated systematic review and meta-analysis of RCTs comparing clinical outcomes with ultrathin-strut DES (≤70 µm strut thickness) with conventional 2nd-generation thin-strut DES.

Methods and results: We performed a random-effects meta-analysis of all RCTs comparing ultrathin-strut DES to conventional 2nd-generation thin-strut DES. The pre-specified primary endpoint was long-term TLF, a composite of cardiac death, myocardial infarction (MI), or clinically driven target lesion revascularization (CD-TLR). Secondary endpoints included the components of TLF, stent thrombosis (ST), and all-cause death. There were 16 eligible trials in which 20 701 patients were randomized. The weighted mean follow-up duration was 2.5 years. Ultrathin-strut DES were associated with a 15% reduction in long-term TLF compared with conventional 2nd-generation thin-strut DES [relative risk (RR) 0.85, 95% confidence interval (CI) 0.76-0.96, P = 0.008] driven by a 25% reduction in CD-TLR (RR 0.75, 95% CI 0.62-0.92, P = 0.005). There were no significant differences between stent types in the risks of MI, ST, cardiac death, or all-cause mortality.

Conclusions: At a mean follow-up of 2.5 years, ultrathin-strut DES reduced the risk of TLF, driven by less CD-TLR compared with conventional 2nd-generation thin-strut DES, with similar risks of MI, ST, cardiac death, and all-cause mortality.

Keywords: Coronary artery disease; Drug-eluting stents; Meta-analysis; Percutaneous coronary intervention; Ultrathin-strut.

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Figures

None
Summary of pooled estimates for key clinical endpoints at latest follow-up. Results from a random-effects meta-analysis of 16 trials in which 20 701 patients were randomized to ultrathin-strut drug-eluting stents (≤70 µm strut thickness) compared with conventional 2nd-generation thin-strut drug-eluting stents. The weighted mean follow-up duration was 2.5 years.
Figure 1
Figure 1
Risk of target lesion failure at latest follow-up.
Figure 2
Figure 2
Risk of target vessel failure at latest follow-up.
Figure 3
Figure 3
Risk of myocardial infarction at latest follow-up.
Figure 4
Figure 4
Risk of definite or probable stent thrombosis at latest follow-up.
Figure 5
Figure 5
Risk of clinically driven revascularization at latest follow-up.
Figure 6
Figure 6
Risk of death at latest follow-up.
See this image and copyright information in PMC

Comment in

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