title: A meta-analysis of 16 randomized trials of sirolimus-eluting stents versus paclitaxel-eluting stents in patients with coronary artery disease.
abstract: OBJECTIVE
  Our purpose was to make a synthesis of the available evidence on the relative efficacy and safety of 2 drug-eluting stents (DES)--sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES)--in patients with coronary artery disease.
  
  
  BACKGROUND
  It is not known whether there are differences in late outcomes between the 2 most commonly used DES: SES and PES.
  
  
  METHODS
  Sixteen randomized trials of SES versus PES with a total number of 8,695 patients were included in this meta-analysis. A full set of individual outcome data from 5,562 patients was also available. Mean follow-up period ranged from 9 to 37 months. The primary efficacy end point was the need for reintervention (target lesion revascularization). The primary safety end point was stent thrombosis. Secondary end points were death and recurrent myocardial infarction (MI).
  
  
  RESULTS
  No significant heterogeneity was found across trials. Compared with PES, SES significantly reduced the risk of reintervention (hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.63 to 0.87, p < 0.001) and stent thrombosis (HR 0.66; 95% CI 0.46 to 0.94, p = 0.02) without significantly impacting on the risk of death (HR 0.92; 95% CI 0.74 to 1.13, p = 0.43) or MI (HR 0.84; 95% CI 0.69 to 1.03, p = 0.10).
  
  
  CONCLUSIONS
  Sirolimus-eluting stents are superior to PES in terms of a significant reduction of the risk of reintervention and stent thrombosis. The risk of death was not significantly different between the 2 DES, but there was a trend toward a higher risk of MI with PES, especially after the first year from the procedure.
authors: Deutsches Herzzentrum, Technische Universität, Munich, Germany. aschoemig@dhm.mhn.de
authors: Albert
authors: A
authors: Schömig
authors: Alban
authors: A
authors: Dibra
authors: Stephan
authors: S
authors: Windecker
authors: Julinda
authors: J
authors: Mehilli
authors: José
authors: J
authors: Suárez de Lezo
authors: Christoph
authors: C
authors: Kaiser
authors: Seung-Jung
authors: SJ
authors: Park
authors: Jean-Jacque
authors: JJ
authors: Goy
authors: Jae-Hwan
authors: JH
authors: Lee
authors: Emilio
authors: E
authors: Di Lorenzo
authors: Jinjin
authors: J
authors: Wu
authors: Peter
authors: P
authors: Jüni
authors: Matthias E
authors: ME
authors: Pfisterer
authors: Bernhard
authors: B
authors: Meier
authors: Adnan
authors: A
authors: Kastrati
mesh_terms: D000368:Aged; D001807:Blood Vessel Prosthesis; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000453:epidemiology; D016503:Drug Delivery Systems; D014943:Global Health; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D017239:Paclitaxel / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents / Q000009:adverse effects; D016019:Survival Analysis; D016896:Treatment Outcome; D050257:Tubulin Modulators / Q000008:administration & dosage*
chemical_list: D007166:Immunosuppressive Agents; D050257:Tubulin Modulators; D017239:Paclitaxel; D020123:Sirolimus