Li MX, Tu HX, Yin MC. Meta-analysis of outcomes from drug-eluting stent implantation in infrapopliteal arteries. World J Clin Cases 2023; 11(22): 5273-5287 [PMID: 37621588 DOI: 10.12998/wjcc.v11.i22.5273]
Corresponding Author of This Article
Hai-Xia Tu, MM, Chief Physician, Department of Vascular Surgery, Beijing Fengtai You'anmen Hospital, No. 199 You'anmenwai Street, Beijing 100069, China. haixia_tu2023@163.com
Research Domain of This Article
Peripheral Vascular Disease
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 6, 2023; 11(22): 5273-5287 Published online Aug 6, 2023. doi: 10.12998/wjcc.v11.i22.5273
Meta-analysis of outcomes from drug-eluting stent implantation in infrapopliteal arteries
Ming-Xuan Li, Hai-Xia Tu, Meng-Chen Yin
Ming-Xuan Li, Hai-Xia Tu, Meng-Chen Yin, Department of Vascular Surgery, Beijing Fengtai You'anmen Hospital, Beijing 100069, China
Author contributions: Li MX designed the study; Li MX and Tu HX performed the article search, data extraction, and evidence quality assessment; Li MX and Yin MC performed the risk of bias assessment of the studies; Li MX performed the data analyses and manuscript writing; Tu HX reviewed the article independently and made minor revisions after consultation with Li MX; All the authors read and gave final approval of the version to be submitted; Tu HX is the guarantor of the review.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to report.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai-Xia Tu, MM, Chief Physician, Department of Vascular Surgery, Beijing Fengtai You'anmen Hospital, No. 199 You'anmenwai Street, Beijing 100069, China. haixia_tu2023@163.com
Received: May 5, 2023 Peer-review started: May 5, 2023 First decision: July 3, 2023 Revised: July 7, 2023 Accepted: July 17, 2023 Article in press: July 17, 2023 Published online: August 6, 2023
Abstract
BACKGROUND
Percutaneous drug-eluting stent implantation (DESI) is an emerging and promising treatment modality for infrapopliteal artery diseases (IPADs). This systematic review and meta-analysis summarizes and quantitatively analyzes the outcomes of DESI in IPADs considering the hazard ratio (HR), which is a more accurate and appropriate outcome measure than the more commonly used relative risk and odds ratio.
AIM
To explore the superiority of drug-eluting stents (DESs) vs traditional treatment modalities for IPADs.
METHODS
The following postoperative indicators were the outcomes of interest: All-cause death (ACD)-free survival, major amputation (MA)-free survival, target lesion revascularization (TLR)-free survival, adverse event (AE)-free survival, and primary patency (PP) survival. The outcome measures were then compared according to their respective HRs with 95% confidence intervals (CIs). The participants were human IPAD patients who underwent treatments for infrapopliteal lesions. DESI was set as the intervention arm, and traditional percutaneous transluminal angioplasty (PTA) with or without bare metal stent implantation (BMSI) was set as the control arm. A systematic search in the Excerpta Medica Database (Embase), PubMed, Web of Science, and Cochrane Library was performed on November 29, 2022. All controlled studies published in English with sufficient data on outcomes of interest for extraction or conversion were included. When studies did not directly report the HRs but gave a corresponding survival curve, we utilized Engauge Digitizer software and standard formulas to convert the information and derive HRs. Then, meta-analyses were conducted using a random-effects model.
RESULTS
Five randomized controlled trials and three cohort studies involving 2639 participants were included. The ACD-free and MA-free survival HR values for DESI were not statistically significant from those of the control treatment (P > 0.05); however, the HR values for TLR-free, AE-free, and PP-survival differed significantly [2.65 (95%CI: 1.56-4.50), 1.57 (95%CI: 1.23-2.01), and 5.67 (95%CI: 3.56-9.03), respectively].
CONCLUSION
Compared with traditional treatment modalities (i.e., PTA with or without BMSI), DESI for IPADs is superior in avoiding TLR and AEs and maintaining PP but shows no superiority or inferiority in avoiding ACD and MA.
Core Tip: The utility of drug-eluting stents (DESs) for infrapopliteal artery diseases was explored using traditional percutaneous transluminal angioplasty with or without bare stent implantation as control. The results suggest that the DES is superior on multiple outcomes. The hazard ratio, which is most appropriate for various outcomes categorized as time-to-event data by type, was adopted as the outcome measure, rather than the relative risk or the odds ratio.
