A meta-analysis of 16 randomized trials of sirolimus-eluting stents versus paclitaxel-eluting stents in patients with coronary artery disease.
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.
Schömig
Albert
A
Deutsches Herzzentrum, Technische Universität, Munich, Germany. aschoemig@dhm.mhn.de
Dibra
Alban
A
Windecker
Stephan
S
Mehilli
Julinda
J
Suárez de Lezo
José
J
Kaiser
Christoph
C
Park
Seung-Jung
SJ
Goy
Jean-Jacque
JJ
Lee
Jae-Hwan
JH
Di Lorenzo
Emilio
E
Wu
Jinjin
J
Jüni
Peter
P
Pfisterer
Matthias E
ME
Meier
Bernhard
B
Kastrati
Adnan
A
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*
D007166:Immunosuppressive Agents; D050257:Tubulin Modulators; D017239:Paclitaxel; D020123:Sirolimus