title: Adjusted indirect comparison of intracoronary drug-eluting stents: evidence from a metaanalysis of randomized bare-metal-stent-controlled trials.
abstract: OBJECTIVE
  Drug-eluting stents (DES) have been recently investigated, with favorable data for many devices, but comparative data are lacking. We thus performed an adjusted indirect comparison metaanalysis of DES.
  
  
  METHODS
  Randomized trials comparing DES vs. bare-metal stents (BMS) were systematically searched, and random effect odds ratios (OR) were computed for target lesion revascularization (TLR) and binary in-stent restenosis rate (BRR) at 6-12 months. We then generated interaction OR for the comparison of different DES.
  
  
  RESULTS
  We pooled data from 17 studies (allocating 3048 patients to BMS and 3392 to nine different DES). Indirect head-to-head comparison of sirolimus-eluting Cypher (N=1007) vs. polymeric paclitaxel-eluting Taxus (N=959) showed nonsignificant differences in TLR [OR=0.8 (0.5-1.4), p=0.45] but significant reductions in BRR favoring Cypher [OR=0.3 (0.1-0.6), p<0.001]. Everolimus-eluting stents appeared noninferior to Cypher or Taxus (p>0.50 for both TLR and BRR). Actinomycin-, mycophenolate-, and apolymeric paclitaxel-eluting stents (PES) all proved significantly worse than Cypher or Taxus for TLR or BRR.
  
  
  CONCLUSIONS
  Notwithstanding its inherent limitations, the present metaanalysis confirms the effectiveness of both Cypher and Taxus, supports the promising role of everolimus-eluting stents, and suggests the significant inferiority of most other devices. These post hoc findings, albeit intriguing, await prospective confirmation.
authors.affiliation: Invasive Cardiology, San Raffaele Hospital, and EMO Centro Cuore Columbus, Milan, Italy. gbiondizoccai@tiscali.it
authors.forename: Giuseppe G L
authors.initials: GG
authors.lastname: Biondi-Zoccai
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.forename: Antonio
authors.initials: A
authors.lastname: Abbate
authors.forename: Luca
authors.initials: L
authors.lastname: Testa
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Marzia
authors.initials: M
authors.lastname: Lotrionte
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.forename: Luigi M
authors.initials: LM
authors.lastname: Biasucci
authors.forename: George W
authors.initials: GW
authors.lastname: Vetrovec
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D003327:Coronary Disease / Q000628:therapy*; D000068338:Everolimus; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016017:Odds Ratio; D017239:Paclitaxel / Q000008:administration & dosage; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D015607:Stents
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D017239:Paclitaxel; D020123:Sirolimus