Meta-analysis of Trials Comparing Drug-eluting Stents with Bare Metal Stents: Safety and Efficacy

Abstract

Background: Effects of drug-eluting stents (DESs) on clinical outcomes as well as stent thrombosis are still under debate. Methods: Our meta-analysis included 26 randomized trials comparing DESs with bare metal stents (BMSs). The endpoints analyzed were all-cause mortality, cardiac death, myocardial infarction (MI), target lesion (TLR) and target vessel (TVR) revascularization, restenosis, and stent thrombosis. Results: In-stent (Risk Ratio = 0.23 [95% confidence interval: 0.17 - 0.32]) and in-segment restenosis (RR = 0.31 [0.24 - 0.40]) significantly reduced in patients with DESs compared with BMSs.  Nonetheless, the all-cause mortality (RR = 0.98 [0.79 - 1.21]) and cardiac death (RR = 0.93 [0.71 - 1.21]) were not significantly different for patients receiving DESs compared with BMSs. DESs versus BMSs resulted in a significant decrease in MI (RR = 0.79 [0.67 - 0.93]), TLR (RR = 0.33 [0.29 - 0.38]), and TVR (RR = 0.47 [0.42 - 0.52]). Stent thrombosis incidence that did not differ in DESs versus BMSs until the first year after implantation, showed an upward trend in DESs compared with BMSs from then on (RR = 3.09 [1.37 - 6.99]).   Conclusions: The use of DESs versus BMSs led to benefits in angiographic restenosis and clinical outcomes. However, higher incidence of long-term stent thrombosis warrants their cautious usage in patients at high-risk of stent thrombosis.