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Meta-Analysis
. 2023 Sep 21;18(9):e0291466.
doi: 10.1371/journal.pone.0291466. eCollection 2023.

Meta-analysis of outcomes from drug-eluting stent implantation in femoropopliteal arteries

Mingxuan Li  1 , Haixia Tu  1 , Yu Yan  1 , Zhen Guo  1 , Haitao Zhu  1 , Jiangliang Niu  1 , Mengchen Yin  1
Affiliations
Meta-Analysis

Meta-analysis of outcomes from drug-eluting stent implantation in femoropopliteal arteries

Mingxuan Li et al. PLoS One. .

Abstract

Objective: In recent years, studies of drug-eluting stent (DES) for femoropopliteal artery diseases (FPADs) have been gradually published. To explore whether this type of stent is superior to the traditional bare metal stent (BMS), we performed this study.

Methods: A systematic search for randomized controlled trials (RCTs) in Excerpta Medica Database (Embase), PubMed, Web of Science (WOS), and Cochrane Library was performed on November 29, 2022. We innovatively adopted the hazard ratio (HR), the most appropriate indicator, as a measure of the outcomes that fall under the category of time-to-event data. The HRs was extracted directly or indirectly. Then, the meta-analyses using random effects model were performed. The bias risks of included papers were assessed by the Cochrane Risk of Bias 2.0 tool. This study was registered on the PROSPER platform (CRD42023391944) and not funded.

Results: Seven RCTs involving 1,889 participants were found. After pooled analyses, we obtained results without propensity on each of the following 3 outcomes of interest: in-stent restenosis (ISR) -free survival, primary patency (PP) survival, and target lesion revascularization (TLR) -free survival (P >0.05, respectively). Because the results of pooled analyses of the other two outcomes of interest (all-cause death free survival and clinical benefit survival) had high heterogeneity both, they were not accepted by us.

Conclusion: For FPADs, the DES has not yet demonstrated superiority or inferiority to BMS, in the ability to maintain PP, avoid ISR and TLR.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flowchart.
Fig 2
Fig 2
Forest plot of ISR-free survival (random effects model, P = 0.058) (A); Sensitivity analysis of the model assuming that each study is omitted separately [ln (HR)] (B); Funnel plot with pseudo 95% confidence limits (C). Abbreviations: HR, hazard ratio; CI, confidence interval; REML, restricted maximum likelihood; BMSI, bare metal stent implantation; DESI, drug-eluting stent implantation; ISR, in-stent restenosis.
Fig 3
Fig 3
Forest plot of PP survival (random effects model with high heterogeneity) (A); Forest plot of PP survival (random effects model with low heterogeneity, P = 0.312) (B); Sensitivity analysis of the model assuming that each study is omitted separately [ln(HR)] (C); Funnel plot with pseudo 95% confidence limits (D). Abbreviations: HR, hazard ratio; CI, confidence interval; REML, restricted maximum likelihood; BMSI, bare metal stent implantation; DESI, drug-eluting stent implantation; PP, primary patency.
Fig 4
Fig 4
Forest plot of TLR-free survival (random effects model, P = 0.089) (A); Sensitivity analysis of the model assuming that each study is omitted separately [ln (HR)] (B); Funnel plot with pseudo 95% confidence limits (C). Abbreviations: HR, hazard ratio; CI, confidence interval; REML, restricted maximum likelihood; BMSI, bare metal stent implantation; DESI, drug-eluting stent implantation; TLR, target lesion revascularization.
Fig 5
Fig 5
Forest plot of ACD survival (random effects model with high heterogeneity) (A); Forest plot of CB survival (random effects model with high heterogeneity) (B). Abbreviations: HR, hazard ratio; CI, confidence interval; REML, restricted maximum likelihood; BMSI, bare metal stent implantation; DESI, drug-eluting stent implantation; ACD, all-cause death; CB, clinical benefit.
See this image and copyright information in PMC

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