The Long-term Efficacy And Safety Of New Drug Eluting Stents: A Meta-analysis

Objective:To perform a meta-analysis of randomized clinical trials(RCTs)comparing the long-term safety and efficacy of new drug-eluting stents(BP-DES and PF-DES)to durable polymer drug-eluting stents(DP-DES).Methods:Two independent reviewers searched Pub Med,Embase,The Cochrane Library,Web of Science,CBM,CNKI,Wangfang,VIP database for RCTs comparing BP-DES/PF-DES to DP-DES until Sep 30,2020,follow up over 5 years.Paired reviewers independently screened citations,assessed risk of bias of included studies,and extracted data.Computations were performed with Rev Man V5.3.Results: 20 RCTs with a total of 25889 patients were selected.Among these RCTs,included 15 RCTs of BP-DES with a total of 221731 patients;included 5 RCTs of PFDES with a total of 4158 patients.We perform a subgroup analysis for these RCTs.The result of subgroup meta-analysis shows that compared with DP-DES,the BPDES reduced the risk of definite/probable stent thrombosis(RR=0.78,95%CI: 0.63-0.98,P=0.03).But there were no statistical significance in any Death(RR=1.03,95%CI:0.96-1.11,P=0.42)、cardiac death(RR=1.02,95%CI:0.89-1.16,P=0.81)、myocardial infarction(RR=0.96,95%CI:0.87-1.06,P=0.47)、target vessel myocardial infarction(RR=0.86,95%CI:0.71-1.03,P=0.11)、 target vessel revascularization(RR=1.06,95%CI:0.97-1.16,P=0.22)、clinically driven target vessel revascularization(RR=1.01,95%CI:0.97-1.15,P=0.91)、target lesion revascularization(RR=1.01,95%CI:0.89-1.15,P=0.91)、clinically driven target lesion revascularization(RR=1.03,95%CI:0.91-1.16,P=0.68)between the two groups.The result of subgroup meta-analysis shows that PF-DES compared to DP-DES,there were no statistical significance in definite/probable stent thrombosis(RR=0.83,95%CI:0.48-1.45,P=0.52),any Death(RR=0.91,95%CI:0.82-1.01,P=0.08),cardiac death(RR=1.00,95%CI:0.87-1.15,P=0.97),Myocardial Infarction(RR=1.00,95%CI:0.77-1.30,P=0.99),target vessel myocardial infarction(RR=0.42,95%CI:0.07-2.64,P=0.35),target vessel revascularization(RR=0.78,95%CI:0.52-1.18,P=0.25),target lesion revascularization(RR=1.03,95%CI:0.89-1.18,P=0.73),clinically driven target lesion revascularization(RR=0.79,95%CI:0.41-1.51,P=0.47).Conclusion: BP-DES could reduce the risk of definite/probable stent thrombosis after percutaneous coronary intervention.PF-DES and DP-DES have similar safety and efficacy.