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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Long-term outcomes of titanium-nitride-oxide coated stents and drug-eluting stents in acute coronary syndrome: A systematic review and meta-analysis
Muhammad Ahmed Ali Fahim, Afia Salman, Hira Anas Khan, Syed Muhammad Hasan, Muskan Fatima Bhojani, Sarah Aslam, Amna Zia Ul Haq, Vishal Reddy Bejugam, Beena Muntaha Nasir, Wajiha Gul, Abdul Moeed, Abdelrahman S Abdalla, Muhammad Majid, Muhammad Sohaib Asghar, Md Al Hasibuzzaman
Muhammad Ahmed Ali Fahim, Afia Salman, Hira Anas Khan, Syed Muhammad Hasan, Muskan Fatima Bhojani, Sarah Aslam, Amna Zia Ul Haq, Beena Muntaha Nasir, Wajiha Gul, Abdul Moeed, Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
Vishal Reddy Bejugam, Department of Internal Medicine, North Central Bronx Hospital, Bronx, NY 10467, United States
Abdelrahman S Abdalla, Department of Urology, Center for Academic Medicine, Stanford University School of Medicine, Palo Alto, CA 33872, United States
Muhammad Majid, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, OH 44195, United States
Muhammad Sohaib Asghar, Division of Nephrology and Hypertension, Mayo Clinic Rochester, Rochester, MN 55905, United States
Md Al Hasibuzzaman, Institute of Nutrition and Food Science, University of Dhaka, Dhaka 1000, Bangladesh
Author contributions: Fahim MAA, Salman A, Khan HA and Moeed A participated in the conceptualization, data curation, investigation, methodology, project administration, resources, supervision, validation, visualization, and writing of the original draft; Hasan SM, Bhojani MF, Aslam S, Haq AZU, Bejugam VR, Nasir BM and Gul W were involved in project administration, and writing of the original draft; Fahim MAA, Moeed A, Abdalla AS, Majid M, Asghar MS and Hasibuzzaman MA were involved in the formal analysis, project administration, supervision, validation, visualization, and writing - review & editing; All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Md Al Hasibuzzaman, MBBS, Doctor, Institute of Nutrition and Food Science, University of Dhaka, Suhrawardi Udyan Road, Dhaka 1000, Bangladesh. al.hasibuzzaman.hasib@gmail.com
Received: February 5, 2024
Revised: April 24, 2024
Accepted: May 13, 2024
Published online: May 26, 2024
Processing time: 108 Days and 2.7 Hours
BACKGROUND
In severe cases of coronary artery disease, percutaneous coronary intervention provide promising results. The stent used could be a drug-eluting stent (DES) or a titanium-nitride-oxide coated stent (TiNOS).
AIM
To compare the 5-year effectiveness and safety of the two stent types.
METHODS
The following systematic review and meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis guidelines, and PubMed/MEDLINE, Scopus, and Cochrane Central were searched from inception till August 2023. Primary outcomes were major adverse cardiac events (MACE), cardiac death, myocardial infarction (MI), cardiac death or MI, and ischemia-driven total lesion revascularization (ID-TLR).
RESULTS
Four randomized controlled trials (RCT), which analyzed a sum total of 3045 patients with acute coronary syndrome (ACS) after a median follow-up time of 5 years were included. Though statistically insignificant, an increase in the ID-TLR was observed in patients receiving TiNOSs vs DESs. In addition, MI, cardiac death and MI, and definite stent thrombosis (DST) were significantly decreased in the TiNOS arm. Baseline analysis revealed no significant results with meta-regression presenting non-ST elevated MI (NSTEMI) as a statistically significant covariate in the outcome of MACE.
CONCLUSION
TiNOS was found to be superior to DES in terms of MI, cardiac death or MI, and DST outcomes, however, the effect of the two stent types on ID-TLR and MACE was not significant. A greater number of studies are required to establish an accurate comparison of patient outcomes in TiNOS and DES.
Core Tip: Acute coronary syndrome (ACS) is characterized by reduced blood flow to the myocardium. While percutaneous coronary intervention with drug-eluting stents (DES) remains the standard management of ACS patients, titanium-nitride-oxide-coated stents (TiNOS) are a relatively newer intervention with relatively lower host immune reactions. In order to facilitate clinical practice guidelines in ACS patients requiring stent placement, it is imperative to compare and assess the safety and efficacy of DES and TiNOS. Therefore, this meta-analysis compared the two interventions in terms of major adverse cardiac events, cardiac death, myocardial infarction, and ischemia-driven total lesion revascularization outcomes.
