D’Ascenzo F, et al. – This study assessed if the type of drug–eluting stent [durable polymer stents [DES] vs. biodegradable polymer stents vs. bioresorbable scaffolds (BRS)] and length of dual antiplatelet therapy (DAPT) influence ischaemic and bleeding events differentially. Findings revealed that regardless of DAPT length, durable and biodegradable polymer stents along with BRS reported a similar rate of Major Adverse Cardiovascular Events (MACE). While everolimus–eluting (EES)/zotarolimus–eluting (ZES) with DAPT > 12 m yielded fewer myocardial infarction (MI) episodes, BRS versus EES/ZES had a higher rate of stent thrombosis (ST), independently from DAPT length. Overall, it was concluded that stent type may partially affect the outcome together with DAPT length.

Methods

• Researchers selected randomized controlled trials comparing different types of DES and/or DAPT durations.
• Major Adverse Cardiovascular Events (MACE) [a composite of death, myocardial infarction (MI), and target vessel revascularization] was the primary endpoint.
• Definite stent thrombosis (ST) and single components of MACE were secondary endpoints.
• The arms of interest were: BRS with 12 months of DAPT (12mDAPT), biodegradable polymer stent with 12mDAPT, durable polymer stent [everolimus-eluting (EES), zotarolimus-eluting (ZES)] with 12mDAPT, EES/ZES with <12 months of DAPT, and EES/ZES with >12 months of DAPT (DAPT > 12 m).

Results

• This analysis included 64 studies with 150 arms and 102 735 patients.
• Findings demonstrated that after a median follow-up of 20 months, MACE rates were similar in the different arms of interest.
• Researchers observed that EES/ZES with DAPT > 12 m reported a lower incidence of MI than the other groups, while BRS showed a higher rate of ST when compared to EES/ZES, irrespective of DAPT length.
• They also observed higher risk of major bleedings for DAPT > 12 m as compared to shorter DAPT.