Titanium-nitride-oxide-coated vs. drug-eluting stents in acute coronary syndromes: an individual patient data meta-analysis.

Summary

Across three ACS RCTs with IPD (n=2743), TiNOS stents achieved similar 5-year MACE and TLR to DES but significantly lowered cardiac death, MI, and stent thrombosis. These safety advantages may influence device selection in ACS.

Key Findings

• No significant difference in 5-year MACE between TiNOS and DES (12.6% vs 16.2%; HR 0.82; P=0.051).
• Similar ischaemia-driven TLR (8.0% vs 8.1%; HR 1.05; P=0.733).
• Significantly lower cardiac death (HR 0.46), MI (HR 0.56), and stent thrombosis (HR 0.30) with TiNOS.

Clinical Implications

TiNOS may be a preferred option in ACS patients at high thrombosis risk or where minimizing stent thrombosis and MI is paramount, with comparable revascularization efficacy.

Limitations

• Primary MACE difference was borderline (P=0.051); efficacy (TLR) was similar.
• Only three RCTs; potential variation in comparator DES generations and practice patterns.

Future Directions

Head-to-head contemporary trials and cost-effectiveness analyses to define subgroups most likely to benefit from TiNOS in ACS.