A meta-analysis of the impact of EPC capture stent on the clinical outcomes in patients with coronary artery disease

Abstract

Background: Damage to the vascular endothelium may be one of the pathophysiological causes of in-stent thrombosis and restenosis. Endothelial progenitor cell (EPC) capture stents (ECS) have the ability to accelerate the damage repair process. However, the clinical outcomes of ECS remain unknown thus far.

Objectives: To evaluate the impact of ECS use on the clinical outcomes of patients with coronary artery disease by comparing ECS to drug-eluting stent (DES) and/or bare metal stent (BMS).

Methods: Studies and abstracts were retrieved from the PubMed, Cochrane Library, and EMBASE online databases and from the conference compilations of the American Heart Association (AHA), the American College of Cardiology (ACC), and Transcatheter Cardiovascular Therapeutics (TCT). These studies were analyzed to investigate whether there was a difference in the clinical therapeutic effects between the ECS group and the DES/BMS group. The primary clinical end-point events were in-stent thrombosis and target lesion revascularization (TLR). The secondary clinical end-point events were target lesion failure (TLF), total mortality, cardiac death, and myocardial infarction (MI).

Results: A total of 2,024 patients were enrolled in the analysis of in-stent thrombosis. There was no significant difference in the incidence of in-stent thrombosis between the ECS group and the DES/BMS group. A total of 1,745 patients were enrolled in the analysis of TLR, and there was no significant difference in the TLR incidence between the ECS group and the DES/BMS group. However, compared with DES, the TLR incidence for ECS increased 1.73-fold (relative risk [RR]: 1.73, 95% confidence interval [95% CI]: 1.01-2.94, P = 0.04). Moreover, the incidence of cardiac death and TLF also increased 3.54-fold (RR: 3.54, 95% CI: 1.13-11.08, P = 0.03) and 1.90-fold (RR: 1.90, 95% CI: 1.05-3.45, P = 0.03), respectively. But compared with BMS, there is no significance of the clinical events.

Conclusion: Compared with DES/BMS use, ECS use may not reduce the incidence of in-stent thrombosis and TLR. In addition, the incidence of TLR and cardiac death with ECS is possibly relatively higher compared with DES and no difference compared with BMS, but this also needs more large RCTs to guarantee.