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| Background Whether drug-eluting stents with biodegradable polymers (BP-DES) improve safety, especially with respect to stent thrombosis (ST) compared with permanent polymers DES (PP-DES), remains uncertainty. We aimed to compare the short- and long-term outcomes and the ST risk in patients treated with BP-DES versus PP-DES. Methods We searched Medline, Embase, Web of science, CENTRAL databases, and conference proceedings/abstracts for randomized controlled trials (RCTs) comparing BP-DES with PP-DES. The primary endpoint was to compare the risks of overall and different temporal categories definite/probable ST. Other clinical outcomes were target lesion revascularization (TLR), myocardial infarction (MI), and all-cause death in short-term (≤1 year) and long-term follow-up. The meta-analyses were performed by computing odds ratios (ORs) with 95% confidence intervals (CIs) using a random-effects model. Results 19 RCTs including 20,229 patients were analysed. Overall, BP-DES significantly decreased the risks of very late definite/probable ST (OR: 0.33; 95% CI: 0.16-0.70), and TLR in long-term follow-up (OR: 0.70; 95% CI: 0.52-0.95) compared with PP-DES. There were no significant differences between the groups regarding MI incidence and mortality during both short and long follow-up period. In strati?ed analyses, the long-term superiority of BP-DES was only maintained by using first-generation DES as the comparators. Conclusions The present meta-analysis indicated that BP-DES were more efficacious than PP-DES at reducing the risks of very late ST and long-term TLR, but it could vary by heterogeneities in the use of PP-DES comparators. Additional rigorous RCTs with longer follow-up periods are warranted to verify these very promising long-term endpoints.
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| Keywords:coronary artery disease; stent; biodegradable polymers; permanent polymers; meta-analysis |
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