Safety and efficacy of drug eluting stents vs bare metal stents in patients with atrial fibrillation: A systematic review and meta-analysis.

Sambola, Antonia; Rello, Pau; Soriano, Toni; Bhatt, Deepak L; Pasupuleti, Vinay; Cannon, Christopher P; Gibson, C Michael; Dewilde, Willem J M; Lip, Gregory Y H; Peterson, Eric D; Airaksinen, K E Juhani; Kiviniemi, Tuomas; Fauchier, Laurent; Räber, Lorenz; Ruiz-Nodar, Juan M; Banach, Maciej; Bueno, Héctor; Hernandez, Adrian V (2020). Safety and efficacy of drug eluting stents vs bare metal stents in patients with atrial fibrillation: A systematic review and meta-analysis. Thrombosis research, 195, pp. 128-135. Elsevier 10.1016/j.thromres.2020.07.010

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OBJECTIVE

A systematic review and meta-analysis was performed to evaluate the safety and efficacy of drug-eluting stents (DES) vs bare-metal stents (BMS) in atrial fibrillation (AF) patients.

METHODS

We systematically searched 5 engines until May 2019 for cohort studies and randomized controlled trials (RCTs). Primary outcomes were major bleeding and major adverse cardiac events (MACE) including cardiac death, myocardial infarction, target vessel revascularization (TVR) or stent thrombosis. Effects of inverse variance random meta-analyses were described with relative risks (RR) and their 95% confidence intervals (CI). We also stratified analyses by type (triple [TAT] vs dual [DAT]) and duration (short-vs long-term) of antithrombotic therapy.

RESULTS

Ten studies (3 RCTs; 7 cohorts) including 10,353 patients (DES: 59.6%) were identified. DES did not show higher risk of major bleeding than BMS (5.6% vs 6.9%, RR 1.07; 95%CI, 0.89-1.28, p = 0.47; I2 = 0%) or MACE (12% vs 13.6%; RR 0.96; 95%CI 0.81-1.13, p = 0.60; I2 = 44%). Although, DES almost decreased TVR risk (6.4% vs 8.4%, RR 0.78; 95%CI, 0.61-1.01, p = 0.06; I2 = 15%). Stratified analyses by type and duration of antithrombotic therapy showed no differences in major bleeding or MACE between both types of stents. In DES, long-term TAT showed higher major bleeding risk than long-term DAT (7.7% vs 4.7%, RR 1.48, 95%CI 1.08-2.03, p = 0.01; I2 = 12%). For both types of stents, MACE risk was similar between TAT and DAT.

CONCLUSIONS

In patients with AF undergoing PCI, DES had similar rate of major bleeding and MACE than BMS. DAT seems to be a safer antithrombotic therapy compared with TAT.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Räber, Lorenz

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0049-3848

Publisher:

Elsevier

Language:

English

Submitter:

Nadia Biscozzo

Date Deposited:

04 Dec 2020 16:35

Last Modified:

04 Dec 2020 16:35

Publisher DOI:

10.1016/j.thromres.2020.07.010

PubMed ID:

32688097

Uncontrolled Keywords:

Antithrombotic therapy Atrial fibrillation Meta-analysis Stent Systematic review

BORIS DOI:

10.7892/boris.147533

URI:

https://boris.unibe.ch/id/eprint/147533

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