Drug-Eluting or Bare-Metal Stents for Left Anterior Descending or Left Main Coronary Artery Revascularization.
Publisher DOI
PubMed ID
34622669
Abstract
Background New-generation drug-eluting stents (DES) reduce target-vessel revascularization compared with bare-metal stents (BMS), and recent data suggest that DES have the potential to decrease the risk of myocardial infarction and cardiovascular mortality. We evaluated the treatment effect of DES versus BMS according to the target artery (left anterior descending [LAD] and/or left main [LM] versus other territories [no-LAD/LM]). Methods and Results The Coronary Stent Trialist (CST) Collaboration gathered individual patient data of randomized trials of DES versus BMS for the treatment of coronary artery disease. The primary outcome was the composite of cardiac death or myocardial infarction. Hazard ratios (HRs) with 95% CIs were derived from a 1-stage individual patient data meta-analysis. We included 26 024 patients across 19 trials: 13 650 (52.4%) in the LAD/LM and 12 373 (47.6%) in the no-LAD/LM group. At 6-year follow-up, there was strong evidence that the treatment effect of DES versus BMS depended on the target vessel (P-interaction=0.024). Compared with BMS, DES reduced the risk of cardiac death or myocardial infarction to a greater extent in the LAD/LM (HR, 0.76; 95% CI, 0.68-0.85) than in the no-LAD/LM territories (HR, 0.93; 95% CI, 0.83-1.05). This benefit was driven by a lower risk of cardiac death (HR, 0.83; 95% CI, 0.70-0.98) and myocardial infarction (HR, 0.74; 95% CI, 0.65-0.85) in patients with LAD/LM disease randomized to DES. An interaction (P=0.004) was also found for all-cause mortality with patients with LAD/LM disease deriving benefit from DES (HR, 0.86; 95% CI, 0.76-0.97). Conclusions As compared with BMS, new-generation DES were associated with sustained reduction in the composite of cardiac death or myocardial infarction if used for the treatment of LAD or left main coronary stenoses. Registration URL: https://www.crd.york.ac.uk/PROSPERO; Unique identifier: CRD42017060520.
Date Issued
2021-10-08
Publication Type
Article
Subjects
bare‐metal stents drug‐eluting stent left anterior descending artery left main disease percutaneous coronary intervention
Language(s)
en
Author(s)
Piccolo, Raffaele | |
Bonaa, Kaare H | |
Varenne, Olivier | |
Urban, Philip | |
Kaiser, Christoph | |
de Belder, Adam | |
Remkes, Wouter | |
Van't Hof, Arnoud W J | |
Stankovic, Goran | |
Lemos, Pedro A | |
Wilsgaard, Tom | |
Reifart, Jörg | |
Rodriguez, Alfredo E | |
Ribeiro, Expedito E | |
Serruys, Patrick W J C | |
Abizaid, Alex | |
Sabaté, Manel | |
Byrne, Robert A | |
de la Torre Hernandez, Jose M | |
Wijns, William | |
Esposito, Giovanni | |
Jüni, Peter |
Journal
Journal of the American Heart Association
Publisher
American Heart Association
ISSN
2047-9980
Access(Rights)
open.access