title: Short- and long-term outcomes with drug-eluting and bare-metal coronary stents: a mixed-treatment comparison analysis of 117 762 patient-years of follow-up from randomized trials.
abstract: BACKGROUND
  Drug-eluting stents (DES) have been in clinical use for nearly a decade; however, the relative short- and long-term efficacy and safety of DES compared with bare-metal stents (BMS) and among the DES types are less well defined.
  
  
  RESULTS
  PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for randomized clinical trials, until March 2012, that compared any of the Food and Drug Administration-approved durable stent and polymer DES (sirolimus-eluting stent [SES], paclitaxel-eluting stent [PES], everolimus-eluting stent [EES], zotarolimus-eluting stent [ZES], and ZES-Resolute [ZES-R]) with each other or against BMS for de novo coronary lesions, enrolling at least 100 patients and with follow-up of at least 6 months. Short-term (≤ 1 year) and long-term efficacy (target-vessel revascularization, target-lesion revascularization) and safety (death, myocardial infarction, stent thrombosis) outcomes were evaluated and trial-level data pooled by both mixed-treatment comparison and direct comparison analyses. From 76 randomized clinical trials with 117 762 patient-years of follow-up, compared with BMS, each DES reduced long-term target-vessel revascularization (39%-61%), but the magnitude varied by DES type (EES~SES~ZES-R>PES~ZES>BMS), with a >42% probability that EES had the lowest target-vessel revascularization rate. There was no increase in the risk of any long-term safety outcomes, including stent thrombosis, with any DES (versus BMS). In addition, there was reduction in myocardial infarction (all DES except PES versus BMS) and stent thrombosis (with EES versus BMS: Rate ratio, 0.51; 95% credibility interval, 0.35-0.73). The safest DES appeared to be EES (>86% probability), with reduction in myocardial infarction and stent thrombosis compared with BMS. Short-term outcomes were similar to long-term outcomes, with SES, ZES-R, and everolimus-eluting stent being the most efficacious and EES being the safest stent.
  
  
  CONCLUSIONS
  DES are highly efficacious at reducing the risk of target-vessel revascularization without an increase in any safety outcomes, including stent thrombosis. However, among the DES types, there were considerable differences, such that EES, SES, and ZES-R were the most efficacious and EES was the safest stent.
authors.affiliation: New York University School of Medicine, The Leon H. Charney Division of Cardiology, New York, NY 10016, USA. sripalbangalore@gmail.com
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.forename: Sunil
authors.initials: S
authors.lastname: Kumar
authors.forename: Mario
authors.initials: M
authors.lastname: Fusaro
authors.forename: Nicholas
authors.initials: N
authors.lastname: Amoroso
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Attubato
authors.forename: Frederick
authors.initials: F
authors.lastname: Feit
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: James
authors.initials: J
authors.lastname: Slater
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000628:therapy*; D023903:Coronary Restenosis / Q000453:epidemiology / Q000517:prevention & control; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000706:statistics & numerical data*; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008670:Metals; D008875:Middle Aged; D017239:Paclitaxel / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors; D020123:Sirolimus / Q000031:analogs & derivatives / Q000627:therapeutic use; D013995:Time; D016896:Treatment Outcome; D050257:Tubulin Modulators / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D008670:Metals; D050257:Tubulin Modulators; D000068338:Everolimus; C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus