Comparative safety and efficacy of a sirolimus-eluting versus paclitaxel-eluting stent: a meta-analysis.
BACKGROUND
Drug-eluting stents have emerged as the favored device for percutaneous coronary intervention. It is not clear if there are differences in the currently available drug-eluting stents. We performed a meta-analysis to systematically evaluate currently available data comparing sirolimus-eluting stents (SESs) with paclitaxel-eluting stents (PESs) in patients with coronary artery disease.


METHODS
We searched the MEDLINE, Embase, ISI Web of Knowledge, Current Contents, and International Pharmaceutical Abstracts databases, and the Cochrane Central Register of Controlled Trials, as well as scientific meeting abstracts up to November 30, 2006. All randomized controlled trials comparing SES with PES and providing follow-up data of > or = 6 months were eligible for inclusion in our analysis.


RESULTS
Data from 12 trials (number of patients 7455) were pooled. There was no difference in death (summary odds ratio [OR] 0.88, 95% CI 0.61-1.25, P = .46), myocardial infarction (summary OR 0.92, 95% CI, 0.71-1.19, P = .51), or stent thrombosis (summary OR 0.75, 95% CI 0.40-1.40, P = .37) between SES and PES. The use of SES was associated with a significant reduction in angiographic restenosis (summary OR 0.64, 95% CI 0.52-0.78, P < .001), target vessel revascularization (5.66% vs 7.70%, summary OR 0.72, 95% CI 0.59-0.88, P = .002), or target lesion revascularization (summary OR 0.67, 95% CI 0.53-0.84, P = .001).


CONCLUSIONS
Patients treated with SES appear to have a significantly lower risk of restenosis and need for target vessel revascularization compared with those treated with PES. There is no significant difference between the 2 stents with respect to mortality, myocardial infarction, or early stent thrombosis.
Gurm
Hitinder S
HS
Division of Cardiovascular Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, MI 48109-0311, USA. hgurm@med.umich.edu
Boyden
Thomas
T
Welch
Kathy B
KB
D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000453:epidemiology; D003328:Coronary Thrombosis / Q000453:epidemiology; D054855:Drug-Eluting Stents; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D015607:Stents