Abstract
BACKGROUND: Various drug-eluting stents (DES) are currently used for percutaneous coronary intervention (PCI). However, long-term trials reveal inconsistent results in head-to-head comparisons. AIMS: To conduct a network meta-analysis of relevant trials to assess the performance of different DES currently used in PCI. METHODS: We systematically searched major databases for randomized controlled trials (RCTs) reporting 5-year outcomes of currently used DES and conducted a network meta-analysis using a frequentist random-effects model with odds ratios (ORs) as effect measures. DES were ranked by P-scores across several outcomes, with definite/probable stent thrombosis as the primary outcome. Statistical analyses were conducted in R software (v4.4.1), with significance set at p < 0.05. RESULTS: Twenty-nine RCTs involving 46,502 patients were included in the analysis. Six currently used DES-Orsiro, Xience, Resolute, Nobori/BioMatrix, Synergy, and Promus-were analyzed. All comparisons showed nonsignificant results for outcomes at 5-year follow-up. Synergy ranked highest for definite/probable stent thrombosis (p = 0.85), all-cause mortality (p = 0.76), cardiac death (p = 0.87), and target vessel revascularization (p = 0.91). Promus ranked best for any myocardial infarction (MI) (p = 0.86), target lesion revascularization (p = 0.93), and target vessel-related MI (p = 0.73). Nobori/BioMatrix ranked highest for target lesion failure (p = 0.80). The newer generation Biofreedom stent also showed nonsignificant results but was excluded from the main analysis due to the availability of 5-year outcomes from only one study. Global and local inconsistencies were nonsignificant for all outcomes and comparisons. CONCLUSION: The analysis revealed no significant differences in 5-year outcomes among the various DES. However, Synergy and Promus performed best for key outcomes such as stent thrombosis, mortality, and MI, suggesting their potential for favorable performance in clinical practice.