Safety and efficacy of drug-eluting stents for patients at high risk of bleedings: A network meta-analysis.

Autor: Giacobbe F; Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Turin, Italy.; Department of Medical Sciences, University of Turin, Turin, Italy., Valente E; Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Turin, Italy.; Department of Medical Sciences, University of Turin, Turin, Italy., Morena A; Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Turin, Italy.; Department of Medical Sciences, University of Turin, Turin, Italy., Nebiolo M; Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Turin, Italy.; Department of Medical Sciences, University of Turin, Turin, Italy., Giannino G; Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Turin, Italy.; Department of Medical Sciences, University of Turin, Turin, Italy., De Filippo O; Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Turin, Italy., Bruno F; Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Turin, Italy., Isaevska E; Department of Medical Sciences, University of Turin, Turin, Italy., Richiardi L; Department of Medical Sciences, University of Turin, Turin, Italy., Iannaccone M; Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy., Zoccai GB; Department of Medical Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.; Mediterranea Cardiocentro, Napoli, Italy., Burzotta F; Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy., D'Ascenzo F; Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Turin, Italy.; Department of Medical Sciences, University of Turin, Turin, Italy., Ferrari GM; Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Turin, Italy.; Department of Medical Sciences, University of Turin, Turin, Italy.
Jazyk: angličtina
Zdroj: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2024 May; Vol. 103 (6), pp. 843-855. Date of Electronic Publication: 2024 Apr 19.
DOI: 10.1002/ccd.31047
Abstrakt: Introduction: Among different coronary stents implanted in High Bleeding Risk (HBR) patients with an indication for short antiplatelet therapy, no comparisons in terms of efficacy have been provided.
Methods: A Network Meta Analysis was performed including all randomized controlled trials comparing different coronary stents evaluated in HBR patients. Major Adverse Cardiovascular Events (MACEs) as defined by each included trial were the primary end point, whereas TLR (target lesion revascularization), TVR (target vessel revascularization), stent thrombosis and total and major (BARC3-5) bleedings were the secondary ones.
Results: A total of four studies (ONYX ONE, LEADERS FREE, SENIOR and HBR in BIO-RESORT) including 6637 patients were analyzed with different kind of stents and dual antiplatelet therapy (DAPT) length (1 or 6 months) on 12 months follow-up. About one-third of these patients were defined HBR due to indication for oral anticoagulation. All drug eluting stents (DESs) reduced risk of MACE compared to Bare Metal Stents (BMSs) when followed by a 1-month DAPT. At SUCRA analysis, Orsiro was the device with the highest probability of performing best. Rates of TLR and TVR were significantly lower when using Resolute Onyx, Synergy and BioFreedom stents in comparison to BMS when followed by 1-month DAPT, with Synergy ranking best. Synergy also showed a significantly lower number of stent thrombosis compared to BMS (RR 0.28, 95% CI 0.06-0.93), while Orsiro and Resolute Integrity showed the highest probability of performing best.
Conclusion: In HBRs patients, all DESs were superior to BMSs in terms of efficacy and safety. Among DESs, Orsiro was the one with the highest ranking in terms of MACE, mainly driven by a reduced incidence of repeated revascularization and stent thrombosis.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
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