Individual Patient Data Meta-analysis of Drug-eluting Versus Bare-metal Stents for Percutaneous Coronary Intervention in Chronic Versus Acute Coronary Syndromes
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https://hdl.handle.net/10037/28876Date
2022-09-06Type
Journal articleTidsskriftartikkel
Peer reviewed
Author
Piccolo, Raffaele; Bønaa, Kaare Harald; Efthimiou, Orestis; Varenne, Olivier; Baldo, Andrea; Urban, Philip; Kaiser, Christoph; de Belder, Adam; Lemos, Pedro A.; Wilsgaard, Tom; Reifart, Jörg; Ribeiro, Expedito E.; Serruys, Patrick WJC; Byrne, Robert A.; de la Torre Hernandez, Jose M.; Esposito, Giovanni; Wijns, William; Jüni, Peter; Windecker, Stephan; Valgimigli, MarcoAbstract
New-generation drug-eluting stents (DES) strongly reduce restenosis and repeat revascu-
larization compared with bare-metal stents (BMS) for percutaneous coronary interven-
tion. There is residual uncertainty as to whether other prognostically relevant outcomes
are affected by DES versus BMS concerning initial presentation (chronic coronary syn-
drome [CCS] vs acute coronary syndrome [ACS]). We performed an individual patient
data meta-analysis of randomized trials comparing new-generation DES versus BMS
(CRD42017060520). The primary outcome was the composite of cardiac death or myocar-
dial infarction (MI). Outcomes were examined at maximum follow-up and with a 1-year
landmark. Risk estimates are expressed as hazard ratio (HR) with 95% confidence inter-
val (CI). A total of 22,319 patients were included across 14 trials; 7,691 patients (34.5%)
with CCS and 14,628 patients (65.5%) with ACS. We found evidence that new-generation
DES versus BMS consistently reduced the risk of cardiac death or MI in both patients
with CCS (HR 0.83, 95% CI 0.70 to 0.98, p <0.001) and ACS (HR 0.83, 95% CI 0.75 to
0.92, p <0.001) (p-interaction = 0.931). This benefit was mainly driven by a similar reduc-
tion in the risk of MI (p-interaction = 0.898) for both subsets (HRCCS 0.80, 95% CI 0.65 to
0.97; HRACS 0.79, 95% CI 0.70 to 0.89). In CCS and ACS, we found a time-dependent
treatment effect, with the benefit from DES accumulating during 1-year follow-up, with-
out offsetting effects after that. In conclusion, patients with CCS were slightly underrepre-
sented in comparative clinical trials. Still, they benefited similarly to patients with ACS
from new-generation DES instead of BMS with a sustained reduction of cardiac death or
MI because of lower event rates within 1 year.
Description
Accepted manuscript version, licensed CC BY-NC-ND 4.0.
Publisher
ElsevierCitation
Piccolo, Bønaa, Efthimiou, Varenne, Baldo, Urban, Kaiser, de Belder, Lemos, Wilsgaard, Reifart, Ribeiro, Serruys, Byrne, de la Torre Hernandez, Esposito, Wijns, Jüni, Windecker, Valgimigli. Individual Patient Data Meta-analysis of Drug-eluting Versus Bare-metal Stents for Percutaneous Coronary Intervention in Chronic Versus Acute Coronary Syndromes. American Journal of Cardiology. 2022;182:8-16Metadata
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