The primary outcome in this analysis was the composite of cardiac death or myocardial infarction.
The researchers suggest from these data on the performance of new-generation drug-eluting stents (DES) in first year after implantation that bare-metal stents (BMS) should no longer be considered the gold standard for safety and further development of DES technology should target improvements in clinical outcomes beyond 1 year.
A commentary commends the authors for providing this meta-analysis since new-generation DES with thinner stent struts have improved safety and efficacy compared with the first-generation DES and they have been associated with a reduced risk of very late stent thrombosis. It concurs with authors that a longer duration of follow-up will confirm whether a time-dependent change to the risk of adverse events will occur regarding the later outcomes of these new-generation DES. Randomised trials that have compared a first-generation versus a second-generation DES have predominantly reported their primary endpoints after 9 or 12 months, but these studies have not predicted the long-term safety and efficacy of these DES after 5 years. It notes this meta-analysis did not examine the potential outcome differences for different types of new-generation DES, such as DES using durable polymers, DES using biodegradable polymers, or polymer-free DES. In addition, the duration of dual antiplatelet therapy was on average 50 days longer after DES implantation versus BMS implantation. However, the Kaplan-Meier curves for myocardial infarction diverged early, but not periprocedurally, indicating an early and late difference between the outcomes of DES and BMS during a period when most of the patients were treated with dual antiplatelet therapy. It suggests that the next step will be to investigate whether the duration of dual antiplatelet therapy can be reduced in new-generation DES treatment, with or without the use of biodegradable polymers, or in patients with a high risk of bleeding.