Polymer-free stents for percutaneous coronary intervention in diabetic patients: a systematic review and meta-analysis

Abstract

Aim: To compare the efficacy of polymer-free drug-eluting stents (PF-DES) versus other stents in diabetic patients with coronary artery disease undergoing percutaneous coronary interventions. Materials & methods: A systematic review and meta-analysis were performed to identify pertinent randomized controlled trials. The primary end point was the occurrence of target lesion failure. Results: Eight randomized controlled trials were included for a total of 4854 subjects. The PF-DES group experienced a trend in favor of a lower rate of target lesion failure (Incidence rate ratio = 0.91; p = 0.11) and a significantly lower rate of cardiac mortality, as compared with the control group (Incidence rate ratio = 0.82; p = 0.04). However, statistical significance was lost if bare-metal stent patients were excluded and a trend in favor of the PF-DES strategy was reported only for cardiac mortality. Conclusion: PF-DES could be a valuable strategy in diabetic patients with coronary artery disease undergoing percutaneous coronary interventions.

Plain language summary

What is this summary about?

Polymer-free drug-eluting stents (PF-DES) are a novel type of coronary stent with potential benefits in terms of chronic coronary inflammation. This is a comprehensive, up-to-date, systematic review and meta-analysis of randomized controlled trials comparing the efficacy of PF-DES versus other stents in diabetic patients with coronary artery disease undergoing percutaneous coronary intervention.

What were the results?

Patients treated with PF-DES experienced similar prognosis, with a trend toward better outcomes, as compared with conventional stents.

What do the results mean?

PF-DES could represent a novel and effective strategy for treating coronary artery disease in diabetic patients.

TWEETABLE ABSTRACT

Polymer-free drug-eluting stents could be a valuable strategy in diabetic patients with coronary artery disease undergoing percutaneous coronary intervention.

GRAPHICAL ABSTRACT

Graphical summary of the study.

IRR: Incidence rate ratio.

Article highlights

Background

• Polymer-free drug-eluting stents (PF-DES) allow for antiproliferative agent release without the presence of polymers, which leads to chronic coronary inflammation and delayed endothelialization of stent struts. Whether PF-DES could provide prognostic benefits as compared with other types of stents in diabetic populations undergoing percutaneous coronary intervention (PCI) is controversial to date.

Methods

• This study was a comprehensive, up-to-date, systematic review and meta-analysis aimed to compare the efficacy of PF-DES versus other stents in diabetic patients undergoing PCI.

Results

• A total of eight randomized controlled trials for a total of 4854 subjects were included in the analysis. There was a trend in favor of PF-DES in the primary end point of target lesion failure (IRR = 0.91, [95% CI: 0.81–1.02]; p = 0.11). PF-DES group experienced a significantly lower rate of cardiac mortality, as compared with the control group (IRR = 0.82, [95% CI: 0.68–0.99]; p = 0.04).

Conclusion

• PF-DES could be a valuable strategy in diabetic patients with coronary artery disease (CAD) undergoing PCI. The pathophysiology underlying these results remains to be addressed. Future larger randomized controlled trials are warranted to address DM subpopulations that could gain more benefit from PF-DES revascularization.

Keywords: :

• atherosclerosis
• diabetes mellitus
• meta-analysis
• percutaneous coronary intervention
• polymer-free drug-eluting stents
• prognosis

Supplemental material

Supplementary data for this article can be accessed at https://doi.org/10.1080/14796678.2024.2370688

Author contributions

FL Gurgoglione and D Donelli: conception and design of the study, analysis and interpretation of data, drafting of the manuscript. M Antonelli: conception and design of the study, analysis, and interpretation of data. L Vignali, G Benatti, E Solinas, and I Tadonio: conception of the study, analysis, and interpretation of data. G Magnani, A Denegri, D Lazzeroni, RA Montone: design of the study, revision of the manuscript. RC Bonadonna, D Ardissino, F Nicolini and G Niccoli: conception of the study, critical revision of the manuscript, and final approval of the manuscript submitted.

Financial disclosure

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.