DOI: 10.1161/circ.148.suppl_1.17686 ISSN: 0009-7322

Abstract 17686: Safety and Efficacy of Drug-Eluting Stents for Patients at High Risk of Bleedings: A Network Meta-Analysis

Federico Giacobbe, Eduardo Valente, Marco Nebiolo, arianna morena, Giuseppe Giannino, Lucrezia Falorni, Mattia Troncone, Ludovica Carmagnola, Emanuele Ravetti, umberto di vita, Ovidio De Filippo, Francesco Bruno, Fabrizio D'Ascenzo, Gaetano Maria De Ferrari
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: Among different coronary stents implanted in High Bleeding Risk (HBR) patients with an indication for short antiplatelet therapy, no comparisons in terms of efficacy have been provided.

Methods: A Network Meta Analysis was performed including all Randomized Controlled Trials comparing different coronary stents evaluated in HBR patients. Major Adverse Cardiovascular Events (MACEs) as defined by each included trial were the primary end point, whereas TLR (target lesion revascularization), TVR (target vessel revascularization), stent thrombosis and total and major (BARC3-5) bleedings were the secondary ones.

Results: A total of 4 studies (ONYX ONE, LEADERS FREE, SENIOR and HBR in BIO-RESORT) including 6637 patients were analyzed with different kind of stents and DAPT length (1 or 6 months) on 12 months follow-up. About one third of these patients were defined HBR due to indication for oral anticoagulation. All Drug Eluting Stents (DESs) reduced risk of MACE compared to Bare Metal Stents (BMSs) when followed by a 1-month DAPT. At SUCRA analysis, Orsiro was the device with the highest probability of performing best. Rates of TLR and TVR were significantly lower when using Resolute Onyx, Synergy and BioFreedom stents in comparison to BMS when followed by 1-month DAPT, with Synergy ranking best. Synergy also showed a significantly lower number of stent thrombosis compared to BMS (RR 0.28, 95%CI 0.06-0.93), while Orsiro and Resolute Integrity showed the highest probability of performing best.

Conclusion: In HBRs patients, all DESs were superior to BMSs in terms of efficacy and safety. Among DESs, Orsiro was the one with the highest ranking in terms of MACE, mainly driven by a reduced incidence of repeated revascularization and stent thrombosis

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