Third generation biodegradable polymer versus polymer free drug-eluting stents: a systematic review

Basile, Emanuela

http://hdl.handle.net/10400.22/29517

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Authors

Basile, Emanuela

Advisor(s)

Baeta, Cristina

Abstract(s)

Third generation drug eluting stents (DES) for percutaneous coronary intervention (PCI) were developed to minimize major outcome problems that previous DES caused during the follow- up, mainly very late stent thrombosis, delayed healing, and inflammation, caused by durable polymer. Among this last generation stent were the biodegradable polymer (BD-DES) and the polymer-free (PF-DES) stents. To analyze the most recent results published in studies addressing clinical outcomes of BD-DES compared with PF-DES in patients undergoing PCI. Methods: This qualitative systematic review was performed following the PRISMA 2020 checklist. The inclusion criteria were publication date between 01-01-2014 and 31-12-2023, open access, PCI with PF-DES or BD-DES, and at least one of these outcomes: cardiac mortality, total mortality/all causes of death, target vessel revascularization, target lesion revascularization, target lesion failure, target vessel failure, late lumen loss, myocardial infarction, stent thrombosis. After screening a total of 701 articles 5 articles were included 2017-2023. Study design differed across studies. Two studies found no significant differences between BP-DES and PF-DES in an all-comers population. One study reported that BP-DES was superior to PF-DES in TLR rates in an all-comers population. One study reported that safety and efficacy profiles were better for PF-DES than the BP-DES only for diabetic patients. The last study found that in patients with moderate to severe coronary artery calcification, the differences in LLL observed at 9 months between the two groups were fully attenuated at 10 years, and no other outcome differed significantly at this point. A meta-analysis was not performed due to the heterogeneity of the studies, but the evaluation of risk of bias was globally low. This review found no significant differences in safety profiles between BP-DES and PF-DES in an all-comers population, aligning with previous findings. However, most studies reported comparable efficacy profiles between the two stent types. Future studies should focus on longer follow-up periods and investigate the potential superiority of PF-DES over BP-DES in patients with diabetes mellitus..