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Interventional cardiology
Original research
Ultrathin-strut biodegradable polymer versus durable polymer drug-eluting stents: a meta-analysis
  1. Mohammad Riashad Monjur1,2,
  2. Christian F Said1,
  3. Paul Bamford1,2,
  4. Michael Parkinson1,
  5. Richard Szirt3 and
  6. Thomas Ford1,2,4
  1. 1Department of Cardiology, Central Coast Local Health District, Gosford, New South Wales, Australia
  2. 2Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
  3. 3Department of Cardiology, St George Hospital, Sydney, New South Wales, Australia
  4. 4Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Thomas Ford; tom.ford{at}health.nsw.gov.au

Abstract

Objectives Determine whether an ultrathin biodegradable polymer sirolimus-eluting stent (‘Orsiro’—BP-SES) has clinical benefits over second-generation durable polymer drug-eluting stents (DP-DES).

Methods We conducted a prospective systematic review and meta-analysis of randomised clinical trials comparing Orsiro BP-SES against DP-DES (PROSPERO Registration: CRD42019147136). The primary outcome was target lesion failure (TLF): composite of cardiac death, target vessel myocardial infarction (TVMI) and clinically indicated target lesion revascularisation (TLR)) evaluated at the longest available follow-up.

Results Nine trials randomised 11 302 patients to either Orsiro BP-SES or DP-DES. At mean weighted follow-up of 2.8 years, the primary outcome (TLF) occurred in 501 of 6089 (8.2%) participants with BP-SES compared with 495 of 5213 (9.5%) participants with DP-DES. This equates to an absolute risk reduction of 1.3% in TLF in favour of Orsiro BP-SES (OR 0.82; 95% CI 0.69 to 0.98; p=0.03). This was driven by a reduction in TVMI (OR 0.80; 95% CI 0.65 to 0.98; p=0.03). There were no significant differences in other clinical endpoints: cardiac death, TLR and stent thrombosis.

Conclusion The Orsiro BP-SES shows promising clinical outcomes in patients undergoing percutaneous coronary intervention compared with contemporary second-generation DES at a short to medium term follow-up. More research is warranted to evaluate performance over a longer follow-up period and in different clinical and lesion subsets.

  • coronary artery disease
  • interventional cardiology
  • coronary intervention (PCI)
  • coronary stenting
  • acute coronary syndrome
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2020-001394

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    Footnotes

    • Contributors MRM contributed to study design, wrote the first draft and performed the statistical analysis. MRM, PB and CFS performed the systematic review. CFS and PB edited the manuscript. MRM and RS extracted the data for analysis. TF checked the data and provided consensus. CFS and MP performed the risk of bias analysis and TF provided consensus. TF devised the study, performed literature review, critically appraised and edited the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Ethics approval was not applicable for this secondary pooled analysis.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data is all available within this manuscript. Methods registered online with PROSPERO (CRD42019147136).