Long-term follow-up shows no difference in TLF among Orsiro, other current-generation DES
In a network meta-analysis of 99,039 patients across 77 trials, the Orsiro ultrathin-strut bioabsorbable-polymer (BP) cobalt chromium sirolimus-eluting stent demonstrated lower rates of target lesion failure (TLF) at 1 year when compared to the Xience, Resolute and Nobori/Biomatrix stents, but this advantage disappeared by 50-month follow-up.
Numerous trials comparing newer contemporary drug-eluting stents (DES) have yielded conflicting results, with some trials demonstrating Orsiro's non-inferiority and even superiority. Nevio Taglieri, MD, of the University of Bologna, Italy, and co-investigators sought to perform a network meta-analysis of contemporary DES trials to clarify the safety and efficacy of currently used DES. Their results were reported in a manuscript published in the Dec. 28 issue of JACC: Cardiovascular Interventions.
The authors included randomized controlled trials published through PubMed, SCOPUS library and proceedings from international meetings comparing contemporary DES. The primary outcome of interest was TLF both at 1 year and long-term follow-up. A total of 99,039 patients in 77 trials were included in the meta-analysis with most investigating 4 DES: Orsiro, Xience, Resolute and Nobori/Biomatrix.
With regard to the primary outcome, the Orsiro DES was found to be associated with a lower rate of TLF at 1-year compared to the Xience DES (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.71-0.98; p=0.03), the Resolute DES (OR, 0.81; 95% CI, 0.68-0.95; p=0.01), and the Nobori/Biomatrix DES (OR, 0.81; 95% CI, 0.67-0.98; p=0.03).
The authors found the Orsiro DES to have the highest probability (70.8%) with a surface under the cumulative ranking curves (SUCRA) value of 95.9%. However, after a median follow-up of 50 months, there were no significant differences in rates of TLF among any of the DES.
Orsiro DES did demonstrate lower rates of long-term stent thrombosis (ST) compared to the In addition, Orsiro had a lower rate of long-term definite stent thrombosis (ST) than the Nobori/Biomatrix DES (OR, 0.60; 95% CI, 0.36-0.98; p=0.04) and a lower rate of definite or probable ST than the Resolute DES (OR, 0.66; 95% CI, 0.45-0.99; p=0.04). Cardiac mortality did not differ among any of the DES.
George D. Dangas, MD, PhD, and Bimmer E. Claessen, MD, PhD, of Mount Sinai Hospital, New York, wrote an accompanying editorial to the study. They begin by commending the efforts of the authors in compiling and analyzing such a large cohort of studies and patients.
The editorialists’ main question is whether DES have fully matured. Furthermore, they reference a meta-analysis of 19 trials of bare metal stents, first-generation DES and contemporary DES, which demonstrating no differences in late outcomes despite improvements in stent technology over the last few decades.
This supports the notion that many are beginning to suspect, that despite improvements in stent technology, late outcomes don't appear to be improving. The answer to the most important question of whether or not there are major differences in safety and efficacy with newer stents appears to be “probably not,” Dangas and Claessen conclude.
Taglieri N, Bruno AG, Ghetti G, et al. Target Lesion Failure with Current Drug Eluting Stents: Evidence from a Comprehensive Network Meta-analysis. JACC Cardiovasc Interv 2020;13:2868–78.
Dangas GD, Claessen BE. Stent Technology Reaches Maturity? JACC Cardiovasc Interv 2020;13:2879–81. DOI: 10.1016/j.jcin.2020.10.004
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