1247 A Vascular Surgeon's Dilemma - Biodegradable Versus Non-Biodegradable Drug Releasing Stents: A Systematic Review and Meta Analysis

Abstract

Abstract Aim Vascular stents are the best-known interventional treatment for cardiovascular disease, and variation in available stents has increased significantly over time. Despite the rapidity of new prototype releases, critical cross-comparisons fail to maintain the same rate, therefore causing confusion for vascular surgeons. Research is most notably lacking between biodegradable-polymer sirolimus-eluting stents (BP-SES) and permanent-polymer sirolimus-eluting stents (PP-SES). Consequently, a systematic review with meta-analysis was conducted evaluating clinical outcomes. Method Medline, Embase, and Scopus databases were searched using relevant synonyms of “biodegradable”, “sirolimus” and “stent”, with the final search being conducted on the 4th of November 2022. Reference lists were also screened. The clinical outcomes investigated were stent thrombosis (ST), myocardial infarction (MI), target vessel revascularisation (TVR), target lesion revascularisation (TLR), and death. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results Five clinical trials directly comparing clinical outcomes between BP-SES and PP-SES were ultimately identified for inclusion. For all five outcomes investigated, no statistically significant difference (p>0.05) was found between the BP-SES and the PP-SES recipients. Pooled odds ratios of 0.86 (95% CI:0.44-1.65), 0.75 (95% CI:0.32-1.74), 1.12 (95% CI:0.54-2.32), 1.14 (95% CI:0.38-3.38) and 0.95 (95% CI:0.51-1.77) were calculated for ST, MI, TVR, TLR and death respectively. Conclusions Although there is some evidence to suggest BP-SES are noninferior to PP-SES, concrete conclusions cannot yet be drawn due to the paucity of research in this field. Further clarity from randomised control trials will aid additional examination and improvement in stent materials and outcomes.