Meta-Analysis
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Feb 26, 2016; 8(2): 240-246
Published online Feb 26, 2016. doi: 10.4330/wjc.v8.i2.240
Biodegradable polymer stents vs second generation drug eluting stents: A meta-analysis and systematic review of randomized controlled trials
Bhavi Pandya, Sainath Gaddam, Muhammad Raza, Deepak Asti, Nikhil Nalluri, Thomas Vazzana, Ruben Kandov, James Lafferty
Bhavi Pandya, Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, United States
Sainath Gaddam, Muhammad Raza, Deepak Asti, Nikhil Nalluri, Thomas Vazzana, Ruben Kandov, James Lafferty, Department of Cardiology, Staten Island University Hospital, Staten Island, NY 10305, United States
Author contributions: Pandya B and Gaddam S were involved in acquisition of data, analysis and interpretation of data, drafting the manuscript; Raza M, Asti D and Nalluri N interpreted data; Vazzana T, Kandov R and Lafferty J critically revised the manuscript, provided their expertise and approved the manuscript.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: No data were created so no data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bhavi Pandya, MBBS, Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, United States. dr.bhavipandya@gmail.com
Telephone: +1-909-9643904 Fax: +1-718-2261528
Received: September 3, 2015
Peer-review started: September 8, 2015
First decision: September 23, 2015
Revised: September 25, 2015
Accepted: November 23, 2015
Article in press: November 25, 2015
Published online: February 26, 2016
Processing time: 172 Days and 0.8 Hours
Abstract

AIM: To evaluate the premise, that biodegradable polymer drug eluting stents (BD-DES) could improve clinical outcomes compared to second generation permanent polymer drug eluting stents (PP-DES), we pooled the data from all the available randomized control trials (RCT) comparing the clinical performance of both these stents.

METHODS: A systematic literature search of PubMed, Cochrane, Google scholar databases, EMBASE, MEDLINE and SCOPUS was performed during time period of January 2001 to April 2015 for RCT and comparing safety and efficacy of BD-DES vs second generation PP-DES. The primary outcomes of interest were definite stent thrombosis, target lesion revascularization, myocardial infarction, cardiac deaths and total deaths during the study period.

RESULTS: A total of 11 RCT’s with a total of 12644 patients were included in the meta-analysis, with 6598 patients in BD-DES vs 6046 patients in second generation PP-DES. The mean follow up period was 16 mo. Pooled analysis showed non-inferiority of BD-DES, comparing events of stent thrombosis (OR = 1.42, 95%CI: 0.79-2.52, P = 0.24), target lesion revascularization (OR = 0.99, 95%CI: 0.84-1.17, P = 0.92), myocardial infarction (OR = 1.06, 95%CI: 0.86-1.29, P = 0.92), cardiac deaths (OR = 1.07, 95%CI 0.82-1.41, P = 0.94) and total deaths (OR = 0.96, 95%CI: 0.80-1.17, P = 0.71).

CONCLUSION: BD-DES, when compared to second generation PP-DES, showed no significant advantage and the outcomes were comparable between both the groups.

Keywords: Stent design; Drug eluting stent; Zotarolimus eluting stent; Cobalt-chromium stent; Biodegradable drug eluting stent

Core tip: No direct comparison has been done so far with biodegradable polymers in drug eluting stent compared to permanent alloy in second-generation drug eluting stent. We explored the efficacy of these two stents via meta-analysis of randomized control trials in terms of definite stent thrombosis, target lesion revascularization, myocardial infarction, cardiac deaths and total deaths.