title: Impact of the everolimus-eluting stent on stent thrombosis: a meta-analysis of 13 randomized trials.
abstract: OBJECTIVE
  We evaluated the impact of the everolimus-eluting stent (EES) on the frequency of stent thrombosis (ST), target vessel revascularization (TVR), myocardial infarction (MI), and cardiac death in randomized controlled trials comparing the EES to non-everolimus-eluting drug-eluting stents (EE-DES).
  
  
  BACKGROUND
  Whether or not the unique properties of the EES translate into reductions in ST remains unknown.
  
  
  METHODS
  We searched MEDLINE, Scopus, the Cochrane Library, and Internet sources for articles comparing outcomes between EES and non-EE-DES without language or date restriction. Randomized controlled trials reporting the frequency of ST were included. Variables relating to patient and study characteristics and clinical endpoints were extracted.
  
  
  RESULTS
  We identified 13 randomized trials (n = 17,101) with a weighted mean follow-up of 21.7 months. Compared with non-EE-DES, the EES significantly reduced ST (relative risk [RR]: 0.55; 95% confidence interval [CI]: 0.38 to 0.78; p = 0.001), TVR (RR: 0.77; 95% CI: 0.64 to 0.92; p = 0.004), and MI (RR: 0.78; 95% CI: 0.64 to 0.96; p = 0.02). There was no difference in cardiac mortality between the groups (RR: 0.92; 95% CI: 0.74 to 1.16; p = 0.38). The treatment effect was consistent by different follow-up times and duration of clopidogrel use. The treatment effects increased with higher baseline risks of the respective control groups with the strongest correlation observed for ST (R(2) = 0.89, p < 0.001).
  
  
  CONCLUSIONS
  Intracoronary implantation of the EES is associated with highly significant reductions in ST with concordant reductions in TVR and MI compared to non-EE-DES. Whether these effects apply to different patient subgroups and DES types merits further investigation.
authors.affiliation: Mount Sinai School of Medicine, Zena and Michael A. Weiner Cardiovascular Institute, 1190 Fifth Avenue–1 South, New York, NY 10029, USA.
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Samin K
authors.initials: SK
authors.lastname: Sharma
authors.forename: Somjot
authors.initials: S
authors.lastname: Brar
authors.forename: Jennifer
authors.initials: J
authors.lastname: Yu
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Suh
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
authors.forename: Antoinette
authors.initials: A
authors.lastname: de Waha
authors.forename: Prakash
authors.initials: P
authors.lastname: Krishnan
authors.forename: Pedro
authors.initials: P
authors.lastname: Moreno
authors.forename: Joseph
authors.initials: J
authors.lastname: Sweeny
authors.forename: Michael C
authors.initials: MC
authors.lastname: Kim
authors.forename: Javed
authors.initials: J
authors.lastname: Suleman
authors.forename: Robert
authors.initials: R
authors.lastname: Pyo
authors.forename: Jose
authors.initials: J
authors.lastname: Wiley
authors.forename: Jason
authors.initials: J
authors.lastname: Kovacic
authors.forename: Annapoorna S
authors.initials: AS
authors.lastname: Kini
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
mesh_terms: D000368:Aged; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D000068338:Everolimus; D005260:Female; D006331:Heart Diseases / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus