Impact of design of coronary stents and length of dual antiplatelet therapies on ischaemic and bleeding events: a network meta-analysis of 64 randomized controlled trials and 102 735 patients
Impact of design of coronary stents and length of dual antiplatelet therapies on ischaemic and bleeding events: a network meta-analysis of 64 randomized controlled trials and 102 735 patients
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DOI：
10.1093/eurheartj/ehx437
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发表时间：
2017-11-07
影响因子：
39.3
通讯作者：
Gaita, Fiorenzo
中科院分区：
文献类型：
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作者：
D'Ascenzo, Fabrizio;Iannaccone, Mario;Gaita, Fiorenzo
Aims药物洗脱支架类型[耐用聚合物支架[DES]与生物可降解聚合物支架与生物可吸收支架（BRS）]和双重抗血小板治疗（DAPT）的长度对缺血和出血事件的差异影响仍有待defined.Methods和Results选择比较不同类型DES和/或DAPT持续时间的随机对照试验。主要终点是主要心血管不良事件（MACE）[死亡、心肌梗死（MI）和靶血管血运重建的复合终点]。明确的支架内血栓形成（ST）和MACE的单一组分是次要终点。感兴趣的武器是：BRS +12个月DAPT（12 mDAPT）、生物可降解聚合物支架+12 mDAPT、耐用聚合物支架[依维莫司洗脱（EES）、佐他莫司洗脱（ZES）]+12 mDAPT、EES/ZES +< 12个月DAPT和EES/ZES +> 12个月DAPT（DAPT > 12 m）。纳入了64项研究，包括150个组和102735例患者。中位随访20个月后，不同关注组的MACE率相似。DAPT > 12 m的EES/ZES报告的MI发生率低于其他组，而与EES/ZES相比，BRS显示ST发生率更高，与DAPT长度无关。DAPT > 12 m的患者发生严重睑缘炎的风险高于DAPT.Conclusion耐用的可生物降解聚合物支架沿着BRS的患者MACE发生率与DAPT长度无关。与EES/ZES相比，DAPT > 12 m的EES/ZES观察到的MI较少，而BRS报告的ST发生率较高，与DAPT长度无关。支架类型可能与DAPT长度一起部分影响结局。
Aims The differential impact on ischaemic and bleeding events of the type of drug-eluting stent [durable polymer stents [DES] vs. biodegradable polymer stents vs. bioresorbable scaffolds (BRS)] and length of dual antiplatelet therapy (DAPT) remains to be defined.Methods and results Randomized controlled trials comparing different types of DES and/or DAPT durations were selected. The primary endpoint was Major Adverse Cardiovascular Events (MACE) [a composite of death, myocardial infarction (MI), and target vessel revascularization]. Definite stent thrombosis (ST) and single components of MACE were secondary endpoints. The arms of interest were: BRS with 12 months of DAPT (12mDAPT), biodegradable polymer stent with 12mDAPT, durable polymer stent [everolimus-eluting (EES), zotarolimus-eluting (ZES)] with 12mDAPT, EES/ZES with < 12 months of DAPT, and EES/ZES with > 12 months of DAPT (DAPT > 12 m). Sixty-four studies with 150 arms and 102 735 patients were included. After a median follow-up of 20 months, MACE rates were similar in the different arms of interest. EES/ZES with DAPT > 12 m reported a lower incidence of MI than the other groups, while BRS showed a higher rate of ST when compared to EES/ZES, irrespective of DAPT length. A higher risk of major bleedings was observed for DAPT > 12 m as compared to shorter DAPT.Conclusion Durable and biodegradable polymer stents along with BRS report a similar rate of MACE irrespective of DAPT length. Fewer MI are observed with EES/ZES with DAPT > 12 m, while a higher rate of ST is reported for BRS when compared to EES/ZES, independently from DAPT length. Stent type may partially affect the outcome together with DAPT length.