Comparative efficacy and safety of latest generation ultrathin and thin biodegradable polymer vs. durable polymer drug-eluting stents in small vessel coronary artery disease: A systematic review and meta-analysis

Abstract

Background: Biodegradable polymer drug-eluting stents (BP-DES) are a well-established treatment for coronary artery disease. However, the long-term efficacy and safety of BP-DES versus durable polymer drug-eluting stents (DP-DES) in patients with small vessel coronary artery disease (SVCAD) remains uncertain.

Methods: We systematically searched PubMed, Embase, and Cochrane Central databases for randomized controlled trials (RCTs) comparing BP-DES versus DP-DES in patients with SVCAD in November 2024. We applied a random-effects model to pool risk ratios (RR) with their 95 % confidence intervals (CIs). All statistical analyses were performed using R software 4.3.1.

Results: We analyzed data from RCTs including 7072 patients for TLF at 1 year, with SVCAD undergoing percutaneous coronary intervention (PCI), of whom 4026 (56.9 %) received BP-DES. Compared to DP-DES, BP-DES were associated with a significantly lower rate of target lesion failure at 2 years (RR 0.81, 95 % CI: 0.67-0.98, p = 0.03) and target vessel myocardial infarction at 1 year (RR: 0.61, 95 % CI: 0.43-0.87, p = 0.006). However, no significant differences in target lesion failure were observed at 1 and 5 years, nor in stent thrombosis. Furthermore, the individual components of TLF-target lesion revascularization, and cardiac death-showed no significant differences between both stent types.

Conclusions: In patients with small vessel coronary artery disease, BP-DES were associated with lower target lesion failure at 2 years and reduced target vessel myocardial infarction at 1 year compared to DP-DES; however, the 2-year TLF benefit was not maintained at 5 years.

Keywords: Biodegradable; Drug-eluting stents; Durable; Percutaneous coronary intervention; Small vessels; Thin; Ultrathin.