Abstract
Background and Objectives: The second-generation drug-eluting stents have been used to treat chronic total occlusion lesion. However, there is limited evidence of the clinical outcomes that whether the second-generation drug-eluting stents is superior to first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The study aimed to compare the differences in clinical outcomes between the two generations drug-eluting stents in patients with those by a meta-analysis.Methods: PubMed, Embase, the Cochrane library and Web of science databases were systemically searched before March, 2021. Randomized controlled trials and observational studies were included to compare the second-generation drug-eluting stents with the first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The clinical outcomes were major adverse cardiac events (MACE), target vessel revascularization, myocardial infarction, all-cause death. Fixed effects models were used to calculate the odds ratio (OR) and 95% confidence interval (CI) of each clinical outcome. Sensitivity analysis was performed to detect potential sources of heterogeneity. Subgroup analyses were used to assess the differential effects.Results: The meta-analysis included eight studies involving 4,583 patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. Pooled analysis showed that the incidence of MACE (OR = 0.68, 95%CI 0.54–0.85, P = 0.0008), target vessel revascularization (OR = 0.70, 95%CI 0.54–0.91, P = 0.007), and myocardial infarction (OR = 0.58, 95%CI 0.37–0.93, P = 0.02) were lower in the second-generation drug-eluting stents compared with the first-generation ones. However, there was not difference in all-cause deaths between two drug-eluting stents (OR = 0.67, 95%CI 0.45–1.01, P = 0.05).Conclusions: The second-generation drug-eluting stents are associated with lower MACE, target vessel revascularization, and myocardial infarction compared with the first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The results of this study can provide a reference for the selection of stents in patients with chronic total occlusion lesion. Further randomized controlled trials are needed to verify that the second-generation drug-eluting stents is superior to the first-generation ones in patients with chronic total occlusion (Registered by PROSPERO, CRD42020158406).
Highlights
Chronic total occlusion (CTO) lesion is characterized by the complete or near complete occlusion of coronary artery with or without minimal downstream flow (TIMI flow grade 0 or 1) for more than 3 months [1]
In patients undergoing coronary angiography, CTO lesion accounted for 25%, and about 50% of CTO lesion were located in the right coronary artery [2, 3]
The in-stent restenosis after CTO-percutaneous coronary intervention (PCI) with bare mental stents was as high as 50%, which undoubtedly hindered its application in this situation [7]
Summary
Chronic total occlusion (CTO) lesion is characterized by the complete or near complete occlusion of coronary artery with or without minimal downstream flow (TIMI flow grade 0 or 1) for more than 3 months [1]. The first-generation drug-eluting stent (DES) was introduced to solve in-stent restenosis in 2002, and its anti-proliferative drugs can inhibit the proliferation of vascular endothelial cells and eliminate neointimal hyperplasia, the incidence of instent restenosis after CTO-PCI was reduced to 7–8.2% [8,9,10]. Compared with first-generation DES, the second-generation DES reduced the risk of very late stent thrombosis by 67–76%, and was recommended by the European Society of Cardiology guidelines (class I, level of evidence A) [12, 13]. The second-generation drug-eluting stents have been used to treat chronic total occlusion lesion. There is limited evidence of the clinical outcomes that whether the second-generation drug-eluting stents is superior to first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The study aimed to compare the differences in clinical outcomes between the two generations drug-eluting stents in patients with those by a meta-analysis
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