Impact of design of coronary stents and length of dual antiplatelet therapies on ischaemic and bleeding events: a network meta-analysis of 64 randomized controlled trials and 102 735 patients

Eur Heart J. 2017 Nov 7;38(42):3160-3172. doi: 10.1093/eurheartj/ehx437.


Aims: The differential impact on ischaemic and bleeding events of 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) remains to be defined.

Methods and results: Randomized controlled trials comparing different types of DES and/or DAPT durations were selected. The primary endpoint was Major Adverse Cardiovascular Events (MACE) [a composite of death, myocardial infarction (MI), and target vessel revascularization]. 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). Sixty-four studies with 150 arms and 102 735 patients were included. After a median follow-up of 20 months, MACE rates were similar in the different arms of interest. 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. A higher risk of major bleedings was observed for DAPT > 12 m as compared to shorter DAPT.

Conclusion: Durable and biodegradable polymer stents along with BRS report a similar rate of MACE irrespective of DAPT length. Fewer MI are observed with EES/ZES with DAPT > 12 m, while a higher rate of ST is reported for BRS when compared to EES/ZES, independently from DAPT length. Stent type may partially affect the outcome together with DAPT length.

Keywords: BRS DES EES ZES; DAPT; DAPT duration; Length of dual antiplatelet therapy; Network meta-analysis; Percutaneous coronary intervention; Stents.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Absorbable Implants
  • Coronary Artery Disease / therapy*
  • Drug Therapy, Combination
  • Drug-Eluting Stents*
  • Hemorrhage / chemically induced
  • Humans
  • Myocardial Ischemia / therapy
  • Network Meta-Analysis
  • Percutaneous Coronary Intervention
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Randomized Controlled Trials as Topic


  • Platelet Aggregation Inhibitors