title: Clinical outcome of drug-eluting versus bare-metal stents in patients with calcified coronary lesions: a meta-analysis.
abstract: BACKGROUND
  The relative safety and efficacy of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients with calcified coronary lesions is still debated.
  
  
  OBJECTIVE
  To evaluate clinical outcome of DES versus BMS in patients with calcified coronary lesions using a meta-analysis of the current literature.
  
  
  METHODS
  We performed a systematic literature search using Medline, Embase, Cochrane and several other databases. Randomised controlled trials, prospective and retrospective cohort studies with a mean follow-up period >6 months were included. Primary efficacy was target lesions revascularisation (TLR) and primary end-point for safety was stent thrombosis. Secondary end-points were cardiac death and recurrent myocardial infarction (MI).
  
  
  RESULTS
  Five trials were included in the meta-analysis, including 2440 patients (1230 in the DES group, 1210 in the BMS group). TLR was significantly lower in patients treated with DES as compared with patients treated with BMS (8.5% vs 16.0%; odds ratio (OR) = 0.50; 95% confidence interval (CI) 0.38-0.65; P < 0.00001). There were no significant differences in the incidence of stent thrombosis (0.9% vs 0.3%; OR = 2.01; 95% CI 0.34-11.88; P = 0.44), cardiac death (3.3% vs 4.2%; OR = 0.81; 95% CI 0.50-1.30; P = 0.38) and recurrent MI (5.0% vs 5.2%; OR = 0.99; 95% CI, 0.66-1.49; P = 0.97) between the two groups. Subgroup analysis by the sample size and follow-up duration showed that the associations were similar between DES versus BMS.
  
  
  CONCLUSIONS
  DES significantly reduces TLR rates as compared with BMS in patients with calcified coronary lesions, with non-significant differences in terms of stent thrombosis, cardiac death and MI.
authors.affiliation: Department of Cardiology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu, China.
authors.forename: B-C
authors.initials: BC
authors.lastname: Zhang
authors.forename: C
authors.initials: C
authors.lastname: Wang
authors.forename: W-H
authors.initials: WH
authors.lastname: Li
authors.forename: D-Y
authors.initials: DY
authors.lastname: Li
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation* / Q000401:mortality; D001315:Australia; D002423:Cause of Death; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D015607:Stents / Q000009:adverse effects; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: calcification; coronary artery disease; meta-analysis; stent