Current DES Performance: Is There Room for Improvement?

Head-to-head comparison of current drug-eluting stents (DES) showed contradictory results that led us to believe, for years, that we had reached a plateau. This feeling was also fostered by the disappointment caused by Absorb and bioresorbable-polymer stents.

However, this recent article featured in JACC Interventions shows a light at the end of the tunnel with a device that appears to be taking off from the plateau.

This meta-analysis included controlled and randomized studies comparing different marketed devices currently available. The primary endpoint was target lesion failure at one year and long-term follow-up.

Overall, 99,030 patients, 77 studies, and 10 different devices were included. Four devices underwent the most extensive investigation: Orsiro, XIENCE, Nobori/BioMatrix, and Resolute.

After a year of follow-up, the Orsiro stent showed the lowest incidence of lesion failure compared with XIENCE (odds ratio [OR]: 0.84; 95% confidence interval [CI]: 0.71 to 0.98; p = 0.03), Resolute (OR: 0.81; 95% CI: 0.68 to 0.95; p = 0.01), and Nobori/BioMatrix (OR: 0.81; 95% CI: 0.67 to 0.98; p = 0.03).

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Orsiro had the highest probability to be the best (70.8%), with an under the cumulative ranking curve value of 95.9%.

However, after a median follow-up period of 50 months (24 to 60 months), there were no significant differences among any DES. Orsiro kept the lead, although its probability of being the best lowered to 58.6%.

Orsiro also had the lowest rate of long-term definite stent thrombosis compared with Nobori/BioMatrix, and the lowest definite or probable stent thrombosis compared with Resolute.

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There were no differences in cardiac mortality among any DES.

Conclusion

The Orsiro stent is associated with a lower one-year target vessel failure rate compared with the XIENCE, Resolute, and Nobori/BioMatrix stents. However, this effect is attenuated in the long-term follow-up.

Original Title: Target Lesion Failure With Current Drug-Eluting Stents Evidence From a Comprehensive Network Meta-Analysis.

Reference: Nevio Taglieri et al. J Am Coll Cardiol Intv 2020;13:2868–78 https://doi.org/10.1016/j.jcin.2020.09.014.

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