title: Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis.
abstract: BACKGROUND
  The relative safety of drug-eluting stents and bare-metal stents, especially with respect to stent thrombosis, continues to be debated. In view of the overall low frequency of stent thrombosis, large sample sizes are needed to accurately estimate treatment differences between stents. We compared the risk of thrombosis between bare-metal and drug-eluting stents.
  
  
  METHODS
  For this network meta-analysis, randomised controlled trials comparing different drug-eluting stents or drug-eluting with bare-metal stents currently approved in the USA were identified through Medline, Embase, Cochrane databases, and proceedings of international meetings. Information about study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted.
  
  
  RESULTS
  49 trials including 50,844 patients randomly assigned to treatment groups were analysed. 1-year definite stent thrombosis was significantly lower with cobalt-chromium everolimus eluting stents (CoCr-EES) than with bare-metal stents (odds ratio [OR] 0·23, 95% CI 0·13-0·41). The significant difference in stent thrombosis between CoCr-EES and bare-metal stents was evident as early as 30 days (OR 0·21, 95% CI 0·11-0·42) and was also significant between 31 days and 1 year (OR 0·27, 95% CI 0·08-0·74). CoCr-EES were also associated with significantly lower rates of 1-year definite stent thrombosis compared with paclitaxel-eluting stents (OR 0·28, 95% CI 0·16-0·48), permanent polymer-based sirolimus-eluting stents (OR 0·41, 95% CI 0·24-0·70), phosphorylcholine-based zotarolimus-eluting stents (OR 0·21, 95% CI 0·10-0·44), and Resolute zotarolimus-eluting stents (OR 0·14, 95% CI 0·03-0·47). At 2-year follow-up, CoCr-EES were still associated with significantly lower rates of definite stent thrombosis than were bare-metal (OR 0·35, 95% CI 0·17-0·69) and paclitaxel-eluting stents (OR 0·34, 95% CI 0·19-0·62). No other drug-eluting stent had lower definite thrombosis rates compared with bare-metal stents at 2-year follow-up.
  
  
  CONCLUSIONS
  In randomised studies completed to date, CoCr-EES has the lowest rate of stent thrombosis within 2 years of implantation. The finding that CoCr-EES also reduced stent thrombosis compared with bare-metal stents, if confirmed in future randomised trials, represents a paradigm shift.
  
  
  BACKGROUND
  The Cardiovascular Research Foundation.
authors.affiliation: Istituto di Cardiologia, Policlinico S Orsola, Bologna, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Diego
authors.initials: D
authors.lastname: Della Riva
authors.forename: Christoph
authors.initials: C
authors.lastname: Stettler
authors.forename: Diego
authors.initials: D
authors.lastname: Sangiorgi
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.forename: Carlo
authors.initials: C
authors.lastname: Briguori
authors.forename: Manel
authors.initials: M
authors.lastname: Sabatè
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Antoinette
authors.initials: A
authors.lastname: De Waha
authors.forename: Elvin
authors.initials: E
authors.lastname: Kedhi
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Smits
authors.forename: Christoph
authors.initials: C
authors.lastname: Kaiser
authors.forename: Gennaro
authors.initials: G
authors.lastname: Sardella
authors.forename: Antonino
authors.initials: A
authors.lastname: Marullo
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D023903:Coronary Restenosis / Q000453:epidemiology / Q000209:etiology*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy; D008297:Male; D017239:Paclitaxel / Q000627:therapeutic use; D011379:Prognosis; D011475:Prosthesis Failure; D011859:Radiography; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D020123:Sirolimus / Q000627:therapeutic use; D015607:Stents / Q000009:adverse effects*; D016019:Survival Analysis; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology*
chemical_list: D017239:Paclitaxel; D020123:Sirolimus