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Different drugs in drug-eluting stents for peripheral artery disease: a systematic evaluation and Bayesian meta-analysis

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Abstract

Drug-eluting stents (DESs) have become the first-line treatment for symptomatic peripheral arterial disease (PAD). Currently, there are many types of DESs on the market. The same type of DESs has different concentrations, and various drugs in them show uneven efficacy. The selection of DESs remains controversial. This study was aimed at comparing the long-term real-world outcomes of different DESs in the treatment of peripheral arterial occlusive disease (PAOD). The databases including Cochrane Library, Embase, and PubMed were searched with a time frame until March 25, 2023. The primary patency (PP) and target lesion revascularization (TLR) at 6 months were used as the primary endpoints. A total of 32 studies (5467 patients) were eligible. At the six-month follow-up, DES-Evero 1 ug/mm2 ranked first in terms of PP, with a significant difference from BMSs (RR [95% CI] = 1.6). DES-Siro 0.9 ug/mm2, DES-Siro 1.4 ug/mm2, DES-Siro 1.95 ug/mm2, DES-PTX 0.167 ug/mm2, DES-PTX 1 ug/mm2 and covered stents (CSs) showed significantly better PPs than BMSs. In terms of TLR, DES-Siro 0.9 ug/mm2 (0.31) ranked first, and DES-Evero 1 ug/mm2 ranked last. Among the treatment modalities for PAD, different DESs showed overall encouraging results in improving PP and TLR compared with BMSs. DES-Evero 1 ug/mm2 showed the best PP, but it had the highest reintervention rate at 6 months. Sirolimus-eluting stents were not always more effective with higher concentrations of sirolimus. Among various DESs, sirolimus-eluting stents and everolimus-eluting stents were superior to paclitaxel-eluting stents.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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This study was supported by Changsha Natural Science Foundation (kq2007060) and Hunan province Natural Science Foundation (2023JJ60065).

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  1. Department of Vascular Surgery, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University (The First Hospital of Changsha), 311 Yingpan Road, Changsha City, 410005, Hunan Province, China

    Keqin Chen

  2. Public Health Clinical Center, Xiangtan Central Hospital, Xiangtan, China

    Lei Xu

  3. Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics, Institute of Emergency Medicine, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha, China

    Xiehong Liu

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Conceptualization: KC. Data curation: KC. Formal analysis: KC. Funding acquisition: KC. Investigation: KC. Methodology: LX. Project administration: LX. Resources: LX. Software: LX. Supervision: XL. Validation: XL. Visualization: XL. Writing—original draft: KC, LX, XL. Writing—review & editing: KC, LX, XL.

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Chen, K., Xu, L. & Liu, X. Different drugs in drug-eluting stents for peripheral artery disease: a systematic evaluation and Bayesian meta-analysis. J Thromb Thrombolysis 57, 520–530 (2024). https://doi.org/10.1007/s11239-023-02932-5

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