title: Safety and efficacy outcomes of first and second generation durable polymer drug eluting stents and biodegradable polymer biolimus eluting stents in clinical practice: comprehensive network meta-analysis.
abstract: OBJECTIVE
  To investigate the safety and efficacy of durable polymer drug eluting stents (DES) and biodegradable polymer biolimus eluting stents (biolimus-ES).
  
  
  METHODS
  Network meta-analysis of randomised controlled trials.
  
  
  METHODS
  Medline, Google Scholar, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) database search for randomised controlled trials comparing at least two of durable polymer sirolimus eluting stents (sirolimus-ES) and paclitaxel eluting stents (paclitaxel-ES), newer durable polymer everolimus eluting stents (everolimus-ES), Endeavor and Resolute zotarolimus eluting stents (zotarolimus-ES), and biodegradable polymer biolimus-ES.
  
  
  METHODS
  Safety (death, myocardial infarction, definite or probable stent thrombosis) and efficacy (target lesion and target vessel revascularisation) assessed at up to one year and beyond.
  
  
  RESULTS
  60 randomised controlled trials were compared involving 63,242 patients with stable coronary artery disease or acute coronary syndrome treated with a DES. At one year, there were no differences in mortality among devices. Resolute and Endeavor zotarolimus-ES, everolimus-ES, and sirolimus-ES, but not biodegradable polymer biolimus-ES, were associated with significantly reduced odds of myocardial infarction (by 29-34%) compared with paclitaxel-ES. Compared with everolimus-ES, biodegradable polymer biolimus-ES were associated with significantly increased odds of myocardial infarction (by 29%), while Endeavor zotarolimus-ES and paclitaxel-ES were associated with significantly increased odds of stent thrombosis. All investigated DES were similar with regards to efficacy endpoints, except for Endeavor zotarolimus-ES and paclitaxel-ES, which were associated with significantly increased the odds of target lesion and target vessel revascularisations compared with other devices. Direction of results beyond one year did not diverge from the findings for up to one year follow-up. Bayesian probability curves showed a gradient in the magnitude of effect, with everolimus-ES and Resolute zotarolimus-ES offering the highest safety profiles.
  
  
  CONCLUSIONS
  The newer durable polymer everolimus-ES and Resolute zotarolimus-ES and the biodegradable polymer biolimus-ES maintain the efficacy of sirolimus-ES; however, for safety endpoints, differences become apparent, with everolimus-ES and Resolute zotarolimus-ES emerging as the safest stents to date.
authors.affiliation: Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
authors.forename: Eliano P
authors.initials: EP
authors.lastname: Navarese
authors.forename: Kenneth
authors.initials: K
authors.lastname: Tandjung
authors.forename: Bimmer
authors.initials: B
authors.lastname: Claessen
authors.forename: Felicita
authors.initials: F
authors.lastname: Andreotti
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kowalewski
authors.forename: David E
authors.initials: DE
authors.lastname: Kandzari
authors.forename: Dean J
authors.initials: DJ
authors.lastname: Kereiakes
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
authors.forename: Laura
authors.initials: L
authors.lastname: Mauri
authors.forename: Ian T
authors.initials: IT
authors.lastname: Meredith
authors.forename: Aloke V
authors.initials: AV
authors.lastname: Finn
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Jacek
authors.initials: J
authors.lastname: Kubica
authors.forename: Harry
authors.initials: H
authors.lastname: Suryapranata
authors.forename: Toni Mustahsani
authors.initials: TM
authors.lastname: Aprami
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Pasquale
authors.forename: Clemens
authors.initials: C
authors.lastname: von Birgelen
authors.forename: Elvin
authors.initials: E
authors.lastname: Kedhi
mesh_terms: D020341:Absorbable Implants; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000517:prevention & control; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000517:prevention & control; D011108:Polymers; D011183:Postoperative Complications / Q000188:drug therapy* / Q000517:prevention & control; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013927:Thrombosis / Q000188:drug therapy* / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D011108:Polymers; D000068338:Everolimus; C489443:zotarolimus; D020123:Sirolimus