Bioresorbable polymer and durable polymer metallic stents in coronary artery disease: a meta-analysis

ABSTRACT

Background

Literature on bioresorbable-polymer-stents (BPS) and second-generation durable-polymer-stents (DPS) in percutaneous coronary intervention (PCI) for all comer CAD is conflicting.

Methods

Randomized controlled studies comparing PCI among BPS and second-generation DPS were identified up until May-2020 from online databases.  Primary outcomes included are all-cause myocardial infarction (MI), cardiac-death, target-vessel-revascularization (TVR), target-vessel MI (TVMI), and stent-thrombosis (ST). Random effect method of risk ratio and confidence interval of 95% was used.

Results

25 prospective randomized controlled trials with 31,822 patients (BPS n = 17,065 and DPS n = 14,757) were included in the study. Follow–up ranged between a minimum of 6 months to more than 5 years. Cardiac death (RR 1.02, 95% CI 0.89–1.45, p = 0.16) was comparable in BPS and second-generation DPS. Risk of all-cause MI was similar between BPS and DPS (RR 0.97, 95% CI 0.84–1.11, p = 0.73). TVMI (RR 0.88, 95% CI 0.69–1.11, p = 0.33) and ST rates were also comparable in BPS and DPS groups (RR 1.06, 95% CI 0.80–1.40, p = 1.00). Overall TVR had comparable outcomes between BPS and DPS (RR 0.95, 95% CI 0.79–1.14, p < 0.001); however, higher TVR was seen among BPS group at follow-up of ≥5 years (RR 1.39, 95% CI 1.12-1.14, p = 0.02). Bias was low and heterogeneity was moderate.

Conclusion

Patients undergoing PCI treated with BPS had comparable outcomes in terms of cardiac death, TVR, ST, TVMI, and all-cause MI to patients treated with second-generation DPS; however, BPS had higher rates of TVR for follow-up of ≥5-years.

KEYWORDS:

• PCI
• durable polymer stent
• bioresorbable polymer stent
• outcomes. coronary artery disease
• percutaneous coronary intervention

Article highlights

• Our study did not find any difference in cardiac mortality, TVR, target vessel MI, and all-cause MI post-PCI among patients treated with bioresorbable versus second-generation durable polymer stent.

• No significant differences in outcomes were found among groups treated with bioresorbable and those treated with second-generation durable polymer stent in terms of duration, type of antithrombotic, and DPS stent types; however, higher TVR was seen among patients BPS on follow-up of ≥5 years.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they have received research, consulting and speaking fees from BBraun, Biotronik, Bayer, BMS, and Sanofi. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.