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dc.contributor.authorWu, James Jun
dc.date.accessioned2019-05-29
dc.date.available2019-05-29
dc.date.issued2019-03-21
dc.identifier.urihttp://hdl.handle.net/2123/20475
dc.description.abstractAdvances in coronary stent technology have revolutionised the treatment of coronary artery disease (CAD) in current clinical practice. Novel stent platforms, such as biodegradable polymer drug-eluting stents (BP-DES) and polymer-free drug-eluting stents (PF-DES), have been developed in recent years to improve on patient outcomes of preceding generations of devices. These new-generation drug-eluting stents (DES) utilise a biocompatible or bioresorbable polymer coating to theoretically eliminate the risk of very late stent thrombosis (ST) associated with the current gold standard durable polymer drug-eluting stents (DP-DES). The permanent polymer coating of DP-DES has been shown to induce a chronic inflammatory response in the vessel wall leading to ST. The performance of new-generation DES compared with DP-DES has not been well appraised in the literature. To summarise the latest clinical evidence, the present thesis included meta-analyses of randomised controlled trials (RCTs) comparing the safety and efficacy profiles of new-generation DES, namely BP-DES and PF-DES, with DP-DES. Subgroup analyses based on anti-proliferative drug, duration of dual antiplatelet therapy (DAPT), and length of follow-up were performed to ascertain if these variables might affect patient outcomes. Landmark analyses were also performed to evaluate late outcomes beyond 1 year. The overall rationale for the present thesis was to provide both qualitative and quantitative assessments of the clinical outcomes of new-generation DES to better inform the ongoing development of clinical practice guidelines for the use of coronary stents in patients with CAD. In summary, new-generation DES and DP-DES conferred equivocal safety and efficacy profiles, with comparable risks of definite or probable ST, myocardial infarction (MI), cardiac death, all-cause death, target lesion revascularisation (TLR), and target vessel revascularisation (TVR). The theoretical advantages of BP-DES and PF-DES over DP-DES were not realised in the meta-analyses. Further RCTs with greater length of follow-up and larger patient population are warranted to determine the purported benefits of these novel stent platforms.en_AU
dc.publisherUniversity of Sydneyen_AU
dc.publisherFaculty of Medicine and Healthen_AU
dc.publisherConcord Clinical Schoolen_AU
dc.rightsThe author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.en_AU
dc.subjectbiodegradable polymeren_AU
dc.subjectcoronary artery diseaseen_AU
dc.subjectdrug-eluting stentsen_AU
dc.subjectdurable polymeren_AU
dc.subjectmeta-analysisen_AU
dc.subjectpolymer-freeen_AU
dc.subject.otherincludes published articlesen_AU
dc.titleClinical outcomes of new-generation drug-eluting stents in patients with coronary artery disease: meta-analyses of randomised controlled trialsen_AU
dc.typeMasters Thesisen_AU
dc.type.pubtypeMaster of Philosophy M.Philen_AU
dc.description.disclaimerAccess is restricted to staff and students of the University of Sydney . UniKey credentials are required. Non university access may be obtained by visiting the University of Sydney Library.en_AU


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