Abstract 20653: Clinical Efficacy and Safety of the Second-Generation Everolimus-Eluting Stents Compared top the First-Generation Paclitaxel-Eluting Stents in Patients With Coronary Artery Disease: Insights From Randomized Trials
Backgrounds: First-generation drug-eluting stents, which released sirolimus or paclitaxel, were shown to be superior to bare-metal stents in reducing the magnitude of neointimal proliferation, the incidence of clinical restenosis, and the need for reintervention. Second-generation drug-eluting stents are designed to provide better stent deployment, safety, and efficacy. We performed a meta-analysis of randomized trials to evaluate the safety and efficacy of a second-generation everolimus-eluting stent (EES) compared with a widely used first-generation paclitaxel-eluting stent (PES) in patients with coronary artery disease (CAD).
Methods: The published literature was scanned by formal searches of electronic databases such as PubMed from January 2001 to April 2010. All randomized trials comparing EESs versus PESs and reporting the outcomes of interest were examined for analysis. Odds ratio (OR) was used as summary estimate. The pooled OR was calculated using the DerSimonian and Laird method for random effects.
Results: A total of 4 randomized trials were included in the present meta-analysis, involving 6,784 patients (4,244 in EES group and 2,540 in PES group). EESs were superior to PESs with respect to the primary end point of major adverse cardiac events (cardiac death, myocardial infarction [MI], and ischemia-driven target lesion revascularization [TLR]) within 12 months of follow-up (4.5% vs. 7.7%, OR 0.57, 95% confidence interval [CI] 0.46–0.70, P < 0.001). The 1-year rates of MI, ischemia-driven TLR and definite or probable (ARC definition) stent thrombosis [ST] were also lower with EESs than with PESs (2.1% vs. 3.9%, OR 0.57, 95% CI 0.43–0.77, P < 0.001 for MI; 2.4% vs. 4.7%, OR 0.49, 95% CI 0.37–0.65, P < 0.001 for TLR; 0.5% vs. 1.5%, OR 0.36, 95% CI 0.15–0.86, P = 0.02 for ST). There was no significant difference between EESs and PESs with respect to cardiac mortality (0.6% vs. 0.7%, OR 0.94, 95% CI 0.52–1.72, P = 0.85) or all-cause mortality (1.2% vs. 1.4% OR 0.95, 95% CI 0.62–1.47; P = 0.83).
Conclusions: The second-generation EESs are better than the first-generation PESs in terms of 1 year safety and efficacy. Longer follow-up data will certainly provide important additional information.
- © 2010 by American Heart Association, Inc.