Meta-analysis of drug-eluting versus bare metal stents in patients with indications for oral anticoagulation undergoing coronary stenting

Abstract

Background Current expert consensus recommends the use of bare metal stent (BMS) for patients with an indication for oral anticoagulation (OAC) undergoing coronary stenting. The use of drug-eluting stents (DES) should be limited. However, there is a lack of evidence to support these recommendations. We performed a meta-analysis to compare the efficacy and safety of DES to BMS in these patients.Methods We searched PubMed, Embase, the Cochrane library, and relevant journals. Studies comparing the efficacy and safety of DES to BMS in patients with an indication for OAC undergoing coronary stenting were included. End points included major adverse cardiac events (MACE), death, bleeding complications, and stroke. The outcome assessments were measured by hazard ratio (HR) and its 95% confidence interval.Results We yielded 453 studies by primary searching. According to the inclusion criteria, four studies enrolling 1,522 patients were finally included. A pooled estimate of HR for MACE, all-cause mortality, myocardial infarction, and bleeding complications showed no significant differences between patients treated with DES and BMS. The risk of target vessel revascularization (TVR) was significantly decreased in the DES implanted patients in comparison with patients with a BMS implantation.Conclusion For patients with an indication for OAC undergoing coronary stenting, DES might a DES can be as safely used as a BMS, and is superior in reducing the risk of TVR.