Abstract 14968: Drug-Eluting Stent for Lower Extremity Peripheral Artery Disease; is It Better Than Percutaneous Angioplasty or Bare-Metal Stent? A Meta-Analysis of Randomized Controlled Trials
Introduction: Current guidelines recommend percutaneous angioplasty as the treatment of choice for lower extremity peripheral artery disease (PAD); stent placement is recommended as a possible alternative. Recent advances in endovascular treatment have made drug-eluting stent (DES) placement a novel option for treatment of PAD with good clinical outcomes. A meta-analysis was performed with the purpose of evaluating the impact of DES in the management of PAD on the effect on clinical outcomes.
Methods: We searched PubMed, Scopus and ClinicalTrials.gov databases until June 2016 for RCTs that compared DES to percutaneous transluminal angioplasty (PTA) or bare-metal stents (BMS) placement for the treatment of lower extremity PAD with a minimal follow up of 6 months. We evaluated the following clinical endpoints: Binary stenosis (>50% stenosis), revascularization (composite of total lesion revascularization and total vessel revascularization), amputations (major and minor) and all-cause mortality. Risk ratios with 95% confidence intervals for clinical endpoints were calculated using random and fixed effect models.
Results: Eight RCTs were included in the analysis, with a total of 1544 patients, 768 in the DES group and 776 in the control group (PTA or BMS). The mean duration of follow up was 16 months. The analysis showed that DES had a statistically significant lower risk of binary stenosis (RR:0.38; 95% CI: 0.28-0.51; p<0.01), revascularization (RR: 0.55; 95% CI: 0.41-0.72; p<0.0001), and amputations (RR: 0.52; 95% CI: 0.32-0.85; p<0.009). There was no significant difference in all-cause mortality (RR: 1.10; p<0.59).
Conclusions: Using the totality of the data available through 2016, this meta-analysis confirms the benefits of DES in reducing the risk of binary stenosis, revascularization and amputations in patients with PAD when compared with PTA or BMS placement, without a significant difference in all-cause mortality.
Author Disclosures: A. Lemor: None. S. Lee: None. A. Casso Dominguez: None. C.A. Gongora: None. F. Gholitabar: None. S. Behuria: None. R.M. Gowda: None.
- © 2016 by American Heart Association, Inc.