The efficacy of sirolimus- and paclitaxel-eluting stents: a meta-analysis of randomized controlled trials.
BACKGROUND
Drug-eluting stents prevent in-stent restenosis after percutaneous coronary intervention, and differences between sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) may exist in the rates of target lesion revascularization, death, myocardial infarction and stent thrombosis.


OBJECTIVE
To compare the efficacy of SES and PES with the efficacy of bare-metal stents for de novo coronary lesions in patients with stable or unstable angina.


METHODS
A meta-analysis of randomized trials from MEDLINE, EMBASE and other electronic databases and conference proceedings was conducted. The efficacy of SES, PES with a polymer carrier (PPOL) and PES without a polymer carrier (PNPOL) was compared using random-effects models.


RESULTS
Ten trials comprising 5041 patients were included in the meta-analysis. There was an absolute decrease in target lesion revascularization of 17% (95% CI 14% to 20%), 9% (95% CI 6% to 11%) and 3% (95% CI 0% to 6%) with SES, PPOL and PNPOL, respectively, with significant differences between SES and PPOL and between PPOL and PNPOL (P < 0.01 for both comparisons). However, sensitivity analysis using the OR of target lesion revascularization showed no difference between SES (OR 0.18 [95% CI 0.12 to 0.26]) and PPOL (OR 0.25 [95% CI 0.16 to 0.37]) (P = 0.26). There were no differences in the incidence of death, myocardial infarction or stent thrombosis, although the small number of events limited the power of these analyses.


CONCLUSIONS
SES show a greater absolute reduction in target lesion revascularization than do PES, likely due to differences in the bare-metal stents used for comparison in the trials. Head-to-head comparisons are needed to directly address the differential efficacy of SES and PES.
Kittleson
Michelle M
MM
Department of Medicine, Division of Cardiology, Epidemiology and Clinical Research, John Hopkins Medical Institute, Baltimore, MD, USA. mkittle1@jhmi.edu
Needham
Dale M
DM
Kim
S Joseph
SJ
Ravindran
Bipin K
BK
Solomon
Sunil S
SS
Guallar
Eliseo
E
D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation* / Q000379:methods; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D012737:Sex Factors; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome
D017239:Paclitaxel; D020123:Sirolimus