Intravascular Ultrasound Comparison Of Second Generation Drug-eluting Stents Versus First Generation Of Drug-eluting Stents: A Meta-analysis

Background: To solve the safety problems of the drug eluting stents inpercutaneous coronary intervention, second generation drug eluting stents emerged atthe proper time. A large number of clinical trials have proved that clinical superiority ofthe second generation drug eluting stent over first generation drug eluting stent, but itsintravascular ultrasound follow-up results remain unknown.Objective: To evaluate the pros and cons of intravascular ultrasound follow-upresults of the second generation and first generation drug-eluting stents in patients withcoronary heart disease.Method: We searched Pubmed，Embase，Cochrane library，Google scholar articleand Chinese Biomedical Literature Database without language restriction. Statisticalanalysis was performed with the Review Manager software (RevMan Version5.23).Study endpoints were incomplete stent apposition, persistent incomplete stentapposition, resolved incomplete stent apposition, late acquire incomplete stentapposition, tissue prolapse, and vessel volume.Result: A total of11randomized control trials included in our study. At follow up,no statistical significant was found in incomplete stent apposition (P=0.49, OR=0.86,95%CI[0.57,1.31], I2=0%), persistent incomplete stent apposition (P=0.49, OR=0.86,95%CI[0.57,1.31], I2=0%) and resolved incomplete stent apposition (P=0.49, OR=1.15,95%CI[0.77,1.72], I2=0%)。But there is statistical significant in late acquire incomplete stent apposition (P＜0.00001, OR=0.22,95%CI[0.12,0.42], I2=0%), tissue prolapse (P＜0.00001, OR=1.15,95%CI[0.77,1.72], I2=0%) and vessel volume (P=0.03,OR=-51.92,95%CI[-97.69,-6.15], I2=0%). In subgroup analysis of zotarolimus elutingstent and paclitaxel eluting stent, there is no statistical significant in incomplete stentapposition (P=0.86, OR=1.04,95%CI[0.69,1.56], I2=0%),persistent incomplete stentapposition (P=0.31, OR=0.75,95%CI[0.42,1.32], I2=0%) and resolved incomplete stentapposition (P=0.24, OR=1.37,95%CI[0.81,2.32], I2=0%). But there is statisticalsignificant in late acquire incomplete stent apposition (P=0.01, OR=0.18,95%CI[0.05,0.71], I2=0%). In comparison of zotarolimus eluting stent and sirolimus eluting stent,there is no statistical significant in incomplete stent apposition (P=0.24, OR=0.69,95%CI [0.38,1.28], I2=0%), persistent incomplete stent apposition (P=0.57, OR=0.78,95%CI [0.33,1.85], I2=0%) and resolved incomplete stent apposition (P=0.22, OR=0.59,95%CI [0.25,1.38], I2=0%). But there is statistical significant in late acquireincomplete stent apposition(P＜0.00001, OR=0.21,95%CI[0.09,0.45], I2=0%).Conclusion: Our analysis demonstrated that the rate of late acquire incompletestent apposition is lower in patients with implantation of second generation drug elutingstent than first generation drug eluting stent. Therefore, the safety of second generationdrug eluting stent is superior over first generation drug eluting stent.