Comparison among ultra-thin coronary stents: a network metanalysis

Abstract

Abstract Background Ultrathin-struts drug eluting stents (DESs) have been related to potential improvement in stent-related outcomes compared to thicker-struts DES. However, comparison among different ultrathin devices are lacking. Methods All Randomized Controlled Trials (RCTs) comparing ultrathin (strut thickness < 70 µm) vs thicker struts DES in an all-comers population were included. Target lesion failure (TLF), as defined by included trials, at one year follow up was the primary endpoint. Cardiovascular (CV) death, myocardial infarction (MI), target lesion revascularization (TLR) and stent thrombosis (ST) were the secondary ones. Arms of included trials were compared by means of Network Meta Analysis (NMA). Results Nine studies encompassing 20081 patients were included: Orsiro DESs were evaluated in 7 arms with 8086 patients, MiStent in one arm (703 patients) and Supraflex in one arm with 720 patients. At one year follow up, no significant differences were noted for TLF. In particular, Orsiro was associated with similar risk of TLF compared with Supraflex (RR 1.7; CI 0.59 - 1.78) and with Xience (RR 0.98; CI 0.71 - 1.35), being the one with the highest probability of performing best. Orsiro stent was the one with the highest probability of performing best also for MI and TLR. Conclusions Ultrathin DES are all associated with a comparable risk of TLF as compared with second generation, thicker struts DES. As for the risk of repeat revascularization and of TLF, Orsiro was the one with the highest probability of performing best, either compared with other ultrathin DES or with thicker-struts devices.TLR: RRs among different devices