Shah R, et al. - In this meta-analysis of randomized clinical trials, researchers tested the effectiveness and safety of drug-eluting stents (DESs) vs bare-metal stents (BMSs) for coronary intervention with 1 month of dual antiplatelet therapy (DAPT). They observed that coronary intervention with specific DESs optimized for biocompatibility was both safe and effective, even with only 1 month of DAPT in patients with a high bleeding risk or were uncertain candidates for prolonged DAPT.

Methods

• Data sources for this analysis were human studies found in PubMed, the Cochrane databases through April 2018, and reference lists of selected articles.
• Researchers included randomized clinical trials if they enrolled patients undergoing percutaneous coronary intervention and randomly assigned each patient to treatment with either DESs or BMSs; use of only 1 month of DAPT following stent implantation was the additional inclusion criterion.
• Two reviewers independently extracted the data, and using random-effects models, odds ratios (ORs) were calculated.
• Major adverse cardiac events, myocardial infarction, target vessel revascularization, ischemia-driven target lesion revascularization, cardiac mortality, and all-cause mortality at 1 year were the efficacy end points.
• Stent thrombosis and bleeding complications were the safety outcomes.

Results

• In this analysis, researchers included data from 3 randomized clinical trials involving 3,943 patients (2,457 men [62.3%]; mean [SD] age ranging from 75.7 [9.3] years to 81.4 [4.3] years per trial subgroup).
• Findings revealed that, at 1 year, coronary intervention with DESs reduced the rates for major adverse cardiac events (OR, 0.68 [95% CI, 0.57-0.82]; P < .001), target lesion revascularization (OR, 0.38 [95% CI, 0.22-0.67]; P=.001), target vessel revascularization (OR, 0.50 [95% CI, 0.38-0.65]; P < .001), and myocardial infarction (OR, 0.51 [95% CI, 0.31-0.83]; P=.01) vs BMSs.
• They found that the incidence of stent thrombosis was also lower with DESs vs BMSs (1.8% vs 2.8%), but this difference was not statistically significant in the random-effects model.
• It was noted that the two stent types did not vary in risks of all-cause mortality, cardiac mortality, and bleeding.