title: Outcomes with first- versus second-generation drug-eluting stents in coronary chronic total occlusions (CTOs): a systematic review and meta-analysis.
abstract: OBJECTIVE
  The objective of the present study was to perform a systematic review and meta-analysis of studies reporting outcomes after first- and second-generation drug-eluting stent (DES) implantation in chronic total occlusions (CTOs).
  
  
  BACKGROUND
  The effect of second- vs first-generation DESs on the outcomes after CTO percutaneous coronary intervention (PCI) has received limited study.
  
  
  METHODS
  As of May 2013, thirty-one published studies reported outcomes after DES implantation in CTOs: thirteen uncontrolled studies (3161 patients), three randomized (220 patients) and ten non-randomized (2150 patients) comparative studies with bare-metal stents (BMSs), and two non-randomized (685 patients) and three randomized (489 patients) comparative studies between first- and second-generation DESs. Data from the five studies comparing first with second-generation DESs were pooled using random-effects meta-analysis models.
  
  
  RESULTS
  The median and mean duration of follow-up were 12 and 14.4 months, respectively. Compared to first-generation DESs, second-generation DESs were associated with lower incidence of death (odds ratio [OR], 0.37; 95% confidence intervals [CI], 0.15-0.91), target vessel revascularization (OR, 0.59; 95% CI, 0.40-0.87), binary angiographic restenosis (OR, 0.68; 95% CI, 0.46-1.01) and reocclusion (OR, 0.35; 95% CI, 0.17-0.71), but similar incidence of myocardial infarction (OR, 0.45; 95% CI, 0.10-1.95) and stent thrombosis (OR, 0.34; 95% CI, 0.07-1.59).
  
  
  CONCLUSIONS
  Compared to first-generation DESs, second-generation DESs are associated with improved angiographic and clinical outcomes in CTO PCI and are the preferred stents for these challenging lesions.
authors.affiliation: VA North Texas Health Care System, The University of Texas Southwestern Medical Center at Dallas, Division of Cardiology (111A), 4500 S. Lancaster Road, Dallas, TX 75216 USA. esbrilakis@gmail.com.
authors.forename: Viswanatha
authors.initials: V
authors.lastname: Lanka
authors.forename: Vishal G
authors.initials: VG
authors.lastname: Patel
authors.forename: Bilal
authors.initials: B
authors.lastname: Saeed
authors.forename: Anna
authors.initials: A
authors.lastname: Kotsia
authors.forename: George
authors.initials: G
authors.lastname: Christopoulos
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.forename: Atif
authors.initials: A
authors.lastname: Mohammad
authors.forename: Michael
authors.initials: M
authors.lastname: Luna
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.forename: Shuaib M
authors.initials: SM
authors.lastname: Abdullah
authors.forename: Jerrold
authors.initials: J
authors.lastname: Grodin
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Hastings
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D054059:Coronary Occlusion / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000145:classification*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation* / Q000379:methods; D013927:Thrombosis; D016896:Treatment Outcome