Abstract 2141: Relationship Between Patient Risk And The Clinical Benefit Of Using Drug-eluting Stents. Metaregression From 31 Randomized Trials.
The objective of the study was to define the relationship between the clinical benefit of drug-eluting stents (DES) and the risk profile of the patients. For this purpose, we have performed a meta-regression analysis from 31 randomized trials comparing DES and bare-metal stents (BMS). The 31 trials included in the meta-reggression evaluated the sirolimus-DES (RAVEL, SIRIUS, E-SIRIUS, C-SIRIUS, SCANDESTENT, DIABETES, SES-SMART, STRATEGY, PRISON-I, BASKET-Cypher, BASKET-AMI-Cypher, TYPHOON, SESAMI, RRISC, and the study by Pache et al), paclitaxel-DES (TAXUS I, II-SR, II-MR, IV, V, VI, PASSION, HAAMU-STENT, BASKET-Taxus, BASKET-AMI-Taxus), zotarolimus-DES (ENDEAVOR-II), everolimus-DES (FUTURE-I, FUTURE-II, SPIRIT-I), tacrolimus-DES (JUPITER-II), and biolimus-DES (STEALTH). Overall, 12,060 patients were included in these trials. The risk profile of the study population (incidence of target lesion revascularization [TLR] in the control group [BMS]) and the clinical benefit of using DES instead of BMS (number of patients needed to treat [NNT] to prevent a TLR) was evaluated, weigthing for the number of patients included in each trial. We found a significant relationship between risk profile and the clinical benefit of using DES: NNT for TLR = 31.1–1.2 (TLR in BMS) (95% CI for β: −1.7, −0.6; p < 0.001) (see figure⇓). In conclusion, the clinical benefit of using DES increases as the risk profile of the patients increases. A 1% incrase in the risk of TLR is associated with a 1.2 decrease in the number of patients needed to be treated to prevent one TLR.