Safety and efficacy of everolimus-eluting stent versus zotarolimus-eluting stent: A meta-analysis of randomized controlled clinical trials and observational studies.
BACKGROUND
The safety and efficacy of everolimus-eluting stent (EES) versus zotarolimus-eluting stent (ZES) are controversial both in randomized controlled clinical trials (RCTs) and observational studies. The aim of this study was to assess the safety and efficacy of EES versus ZES.


METHODS
Pubmed, Embase, Cochrane database and www.clinicaltrials.gov updated to Mar 2014 with safety [major adverse cardiac events (MACE)], all-cause mortality, non-fatal myocardial infarction (MI), stent thrombosis (ST) and efficacy [target vessel revascularization (TVR), target lesion revascularization (TLR), target vessel failure (TVF), target lesion failure (TLF)] endpoints and follow-up of ≥12 months were identified.


RESULTS
Data from 11,778 patients in 8 RCTs and 34,850 patients in 26 observational studies were included. In RCT studies, no evidence indicating that EES was safer or more efficacious than ZES. In observational studies, EES associated with a significantly lower risk for MACE (RR: 0.56, 95% CI: 0.46-0.69), ST (RR: 0.59, 95% CI: 0.45-0.78), TVR (RR: 0.61, 95% CI: 0.47-0.79), TLR (RR: 0.57, 95% CI: 0.38-0.83) and TLF (RR: 0.69, 95% CI: 0.50-0.93). The pooled data of RCTs and observational studies showed that compared to ZES, EES associated with a significant lower risk for MACE (RR: 0.65, 95% CI: 0.54-0.78), ST (RR: 0.66, 95% CI: 0.52-0.83), TVR (RR: 0.72, 95% CI: 0.58-0.89), TLR (RR: 0.63, 95% CI: 0.49-0.82) and TLF (RR: 078, 95% CI: 0.62-1.00).


CONCLUSIONS
In RCTs, EES and ZES showed comparable safety and efficacy, while in observational studies or pooled data, EES was safer and more efficacious than ZES.
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100037, People's Republic of China; Peking Union Medical College, Beijing 100037, People's Republic of China.
Hongqiu
H
Gu
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100037, People's Republic of China; Peking Union Medical College, Beijing 100037, People's Republic of China.
Kun
K
Hua
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100037, People's Republic of China; Peking Union Medical College, Beijing 100037, People's Republic of China. Electronic address: liwei@mrbc-nccd.com.
Wei
W
Li
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100037, People's Republic of China; Peking Union Medical College, Beijing 100037, People's Republic of China.
Yang
Y
Wang
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100037, People's Republic of China; Peking Union Medical College, Beijing 100037, People's Republic of China.
Jingan
J
Yang
D003324:Coronary Artery Disease / Q000601:surgery*; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000494:pharmacology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D064887:Observational Studies as Topic; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000494:pharmacology; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D000068338:Everolimus; C489443:zotarolimus; D020123:Sirolimus
Efficiency; Everolimus-eluting stent; Meta-analysis; Safety; Zotarolimus-eluting stent