Drug-Eluting Stents Versus Bare-Metal Stents in Large Coronary Artery Revascularization: Systematic Review and Meta-Analysis

Objectives: We aimto determine if drug eluting stents (DES) are better than bare-metal stents (BMS) in large coronary artery (diameter >= 3 mm) percutaneous coronary intervention (PCI). Background: DES have become the standard of care for PCI in coronary artery disease (CAD). However, the superiority of DES over BMS in large vessel CAD is not clear and previous studies have shown conflicting results. Methods: Randomized controlled trials (RCTs) comparing outcomes of PCI with BMS and DES for large vessel CAD were identified from the year 2000 to August 2019. The outcomes were studied individually and included allcause mortality, myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis. Aggregated odds ratio and 95% CI were calculated using a random-effects model. Results: Eight RCTswere included (4 with data for first-generation DES, 3 with data for second-generation DES, and 1 with data for both first- and second-generation DES). Compared to BMS, second generation DES had a significantly lower rate of all-cause mortality (2.4%vs. 3.9%, OR0.74, 95%CI0.56-0.98, P0.04), TLR (3.5%vs.8.6%OR 0.38 95% CI0.28-0.53,P < 0.001), and MI (2.1%vs. 2.9%OR0.73 95%CI 0.53-1.0, P 0.05). The difference in allcause mortality was not seen with first-generation DES. Conclusion: Newer DES are associatedwith a lowermortality, TLR, and MI and thus should be preferred overBMS for large coronary artery PCI. (C) 2020 Elsevier Inc. All rights reserved.