Does direct stenting with drug‐eluting stents improve outcome? A meta‐analysis of 10,900 patients

Objectives The aim of this study is to summarize the outcomes of patients undergoing direct stenting (DS) with drug-eluting stents (DES) compared to those who underwent balloon predilatation. Background DS has been associated with improved outcomes in the bare-metal stent era. Although DS with DES implantation has been increasingly adopted in clinical practice, its safety and effectiveness remain controversial. Methods The search criteria identified 546 studies in the Medline/PubMed, Cochrane, and EMBASE databases from 2001 to July 2014. From these, seven studies totaling 10,900 patients were selected. Summarized estimates [odds ratio (OR) and 95% confidence intervals] were obtained using a random-effects model. The primary outcomes were a composite of major adverse cardiac events (MACE), including all-cause death, myocardial infarction (MI), and repeat revascularization. The secondary outcomes included a composite of death and MI and the rates of target lesion revascularization (TLR). Results Overall, 4101 (38%) and 6799 (62%) patients underwent DS with DES and balloon pre-dilatation, respectively. DS with DES reduced the likelihood of MACE (OR: 0.81 [0.71–0.93]). Additionally, DS with DES was associated with reduced rates of death/MI (OR: 0.76 [0.62–0.92]), and TLR (OR: 0.66 [0.44–0.98]). Conclusions DS with DES is safe and may be associated with better outcomes in selected patients. © 2016 Wiley Periodicals, Inc.