Thuemmler Rosa J, Choudhary Trisha, Tan Yong Hui, Andrei Maria-Bianca, Liu Haipeng, Kumar Niraj S
Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen United Kingdom.
National Medical Research Association, Leicester, United Kingdom.
PLoS One. 2025 Mar 19;20(3):e0319946. doi: 10.1371/journal.pone.0319946. eCollection 2025.
More than 3 million individuals globally experience STEMI each year, with percutaneous coronary intervention (PCI) as the preferred revascularization method. While second-generation Drug Eluting Stents (DES) reduce restenosis compared to bare-metal stents, complications such as neoatherosclerosis and stent thrombosis remain. Second-generation stents, including durable polymer (DP-DES) and biodegradable polymer (BP-DES), aim to improve outcomes, though guidelines do not specify a preference. Given mixed results from prior studies and new long-term data, we aim to perform a systematic review and meta-analysis comparing long-term outcomes of DP-DES vs. BP-DES following PCI.
This protocol has been developed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. MEDLINE, Embase, and Scopus databases will be searched for eligible observational and interventional studies from inception up to 5th of October 2024. Screening (title/abstract and full text), data extraction, risk of bias assessment, and quality of evidence assessment will be conducted by two independent reviewers. A random-effects model will be used to meta-analyse outcomes.
DES have greatly advanced PCI for STEMI. However, long-term stent thrombosis remains an issue due to chronic inflammation and impaired healing from the stent's polymer coating. To overcome this, BP-DES were introduced to dissolve their coating within 2-9 months. However, whether BP-DES offers superior long-term outcomes compared to second-generation DP-DES remains uncertain. While previous meta-analyses have shown similar outcomes, recent studies suggest BP-DES may offer better long-term results. This review will compare long-term outcomes (≥5 years) of BP-DES vs. DP-DES, providing important insights to inform clinical practice. Systematic review registration: PROSPERO (CRD42024592579).
全球每年有超过300万人发生ST段抬高型心肌梗死（STEMI），经皮冠状动脉介入治疗（PCI）是首选的血运重建方法。与裸金属支架相比，第二代药物洗脱支架（DES）可减少再狭窄，但仍存在新动脉粥样硬化和支架血栓形成等并发症。第二代支架，包括耐用聚合物（DP-DES）和可生物降解聚合物（BP-DES），旨在改善治疗效果，尽管指南并未明确表明偏好。鉴于先前研究结果不一以及新的长期数据，我们旨在进行一项系统评价和荟萃分析，比较PCI术后DP-DES与BP-DES的长期疗效。
本方案是根据系统评价和荟萃分析方案的首选报告项目制定的。将检索MEDLINE、Embase和Scopus数据库，以查找从数据库创建至2024年10月5日的符合条件的观察性和干预性研究。筛选（标题/摘要和全文）、数据提取、偏倚风险评估和证据质量评估将由两名独立的评审员进行。将使用随机效应模型对结果进行荟萃分析。
DES极大地推动了STEMI的PCI治疗。然而，由于慢性炎症和支架聚合物涂层导致的愈合受损，长期支架血栓形成仍然是一个问题。为了克服这一问题，引入了BP-DES，使其涂层在2至9个月内溶解。然而，与第二代DP-DES相比，BP-DES是否能提供更好的长期疗效仍不确定。虽然之前的荟萃分析显示结果相似，但最近的研究表明BP-DES可能提供更好的长期结果。本综述将比较BP-DES与DP-DES的长期疗效（≥5年），为临床实践提供重要见解。系统评价注册：PROSPERO（CRD42024592579）。
