Effects of cobalt-chromium everolimus eluting stents or bare metal stent on fatal and non-fatal cardiovascular events: patient level meta-analysis.
OBJECTIVE
To examine the safety and effectiveness of cobalt-chromium everolimus eluting stents compared with bare metal stents.


METHODS
Individual patient data meta-analysis of randomised controlled trials. Cox proportional regression models stratified by trial, containing random effects, were used to assess the impact of stent type on outcomes. Hazard ratios with 95% confidence interval for outcomes were reported.


METHODS
Medline, Embase, the Cochrane Central Register of Controlled Trials. Randomised controlled trials that compared cobalt-chromium everolimus eluting stents with bare metal stents were selected. The principal investigators whose trials met the inclusion criteria provided data for individual patients.


METHODS
The primary outcome was cardiac mortality. Secondary endpoints were myocardial infarction, definite stent thrombosis, definite or probable stent thrombosis, target vessel revascularisation, and all cause death.


RESULTS
The search yielded five randomised controlled trials, comprising 4896 participants. Compared with patients receiving bare metal stents, participants receiving cobalt-chromium everolimus eluting stents had a significant reduction of cardiac mortality (hazard ratio 0.67, 95% confidence interval 0.49 to 0.91; P=0.01), myocardial infarction (0.71, 0.55 to 0.92; P=0.01), definite stent thrombosis (0.41, 0.22 to 0.76; P=0.005), definite or probable stent thrombosis (0.48, 0.31 to 0.73; P<0.001), and target vessel revascularisation (0.29, 0.20 to 0.41; P<0.001) at a median follow-up of 720 days. There was no significant difference in all cause death between groups (0.83, 0.65 to 1.06; P=0.14). Findings remained unchanged at multivariable regression after adjustment for the acuity of clinical syndrome (for instance, acute coronary syndrome v stable coronary artery disease), diabetes mellitus, female sex, use of glycoprotein IIb/IIIa inhibitors, and up to one year v longer duration treatment with dual antiplatelets.


CONCLUSIONS
This meta-analysis offers evidence that compared with bare metal stents the use of cobalt-chromium everolimus eluting stents improves global cardiovascular outcomes including cardiac survival, myocardial infarction, and overall stent thrombosis.
Thoraxcenter, Erasmus Medical Center, 3015 CE Rotterdam, Netherlands m.valgimigli@erasmusmc.nl.
Marco
M
Valgimigli
University Hospital Clinic, IDIBAPS, Cardiology Department, 08036 Barcelona, Spain.
Manel
M
Sabaté
University Hospital 4003 Basel, Switzerland.
Christoph
C
Kaiser
University Hospital Clinic, IDIBAPS, Cardiology Department, 08036 Barcelona, Spain.
Salvatore
S
Brugaletta
Hospital Marqués de Valdecilla, 39008 Santander, Spain.
Jose Maria
JM
de la Torre Hernandez
Gentofte Hospital, 2900 Hellerup, Denmark.
Soeren
S
Galatius
University Hospital of Bellvitge, 08907 Barcelona, Spain.
Angel
A
Cequier
Stadtspital Triemli, 8063 Zürich, Switzerland.
Franz
F
Eberli
Brighton and Sussex University Hospitals NHS Trust, Brighton BN1 6AG, UK.
Adam
A
de Belder
Thoraxcenter, Erasmus Medical Center, 3015 CE Rotterdam, Netherlands.
Patrick W
PW
Serruys
Interventional Cardiology, Humanitas Clinical and Research Institute IRCCS, 20089 Rozzano, Milan, Italy.
Giuseppe
G
Ferrante
D002857:Chromium; D003035:Cobalt; D003324:Coronary Artery Disease / Q000150:complications* / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D000068338:Everolimus; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality; D020123:Sirolimus / Q000031:analogs & derivatives; D015607:Stents / Q000009:adverse effects; D013927:Thrombosis / Q000209:etiology*; D016896:Treatment Outcome
D002857:Chromium; D003035:Cobalt; D000068338:Everolimus; D020123:Sirolimus