title: Zotarolimus-eluting stent versus sirolimus-eluting and paclitaxel-eluting stents for percutaneous coronary intervention: a meta-analysis of randomized trials.
abstract: BACKGROUND
  The zotarolimus-eluting stent (ZES) is a new drug-eluting stent that delivers zotarolimus, a synthetic analogue of sirolimus, through a biocompatible phosphorylcholine polymer coating. ZES has shown promising results compared with bare-metal stents, but its safety and efficacy against sirolimus-eluting (SES) and paclitaxel-eluting (PES) stents is yet to be established.
  
  
  OBJECTIVE
  We aimed to summarize current evidence from randomized trials comparing ZES with SES and PES.
  
  
  METHODS
  We searched the Medline, Embase and CENTRAL databases for randomized studies comparing ZES with SES and PES for percutaneous coronary intervention. Relevant clinical and angiographic outcomes were extracted and combined using random and fixed-effect models for heterogeneous and homogenous outcomes, respectively.
  
  
  RESULTS
  Seven randomized trials met the inclusion criteria: ZES group, n=3787; SES group, n=2606; PES group, n=1966. Compared with SES, ZES was associated with significantly higher odds of clinically driven target vessel revascularization (odds ratio [OR] 2.36, 95% confidence interval [CI] 1.78-3.14) and target lesion revascularization (OR 2.46, 95% CI 1.36-4.46). Compared with SES, ZES had higher in-stent restenosis (OR 6.13, 95% CI 3.96-9.50), late lumen loss 'in-stent' (mean difference [MD] 0.39 mm, 95% CI 0.34-0.44) and late lumen loss 'in-segment' (MD 0.18 mm, 95% CI 0.15-0.21). ZES was associated with higher in-stent late lumen loss than PES (MD 0.18 mm, 95% CI 0.07-0.28). There were no differences in mortality, reinfarction or stent thrombosis with ZES compared with SES and PES.
  
  
  CONCLUSIONS
  ZES is not superior to PES and is inferior to SES in terms of angiographic outcomes and clinically driven revascularization.
authors.affiliation: Department of Medicine, Rosalind Franklin University of Medicine and Sciences, North Chicago, IL 60064, USA. drankursethi@gmail.com
authors.forename: Ankur
authors.initials: A
authors.lastname: Sethi
authors.forename: Amol
authors.initials: A
authors.lastname: Bahekar
authors.forename: Rohit
authors.initials: R
authors.lastname: Bhuriya
authors.forename: Anurag
authors.initials: A
authors.lastname: Bajaj
authors.forename: Param Puneet
authors.initials: PP
authors.lastname: Singh
authors.forename: Rohit
authors.initials: R
authors.lastname: Arora
authors.forename: Sandeep
authors.initials: S
authors.lastname: Khosla
mesh_terms: D020099:Coated Materials, Biocompatible; D016001:Confidence Intervals; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000517:prevention & control*; D054855:Drug-Eluting Stents; D004868:Equipment Failure; D005500:Follow-Up Studies; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D017239:Paclitaxel / Q000008:administration & dosage / Q000627:therapeutic use; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation*; D010767:Phosphorylcholine; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible; D010767:Phosphorylcholine; C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus