Abstract 20754: Comparison by Meta-Analysis of Zotarolimus-Eluting and Sirolimus-Eluting Stents in Patients With Coronary Artery Disease
Background: Clinical trials comparing a second-generation zotarolimus-eluting stent (ZES) versus an extensively used and validated first-generation sirolimus-eluting stent (SES) have reported conflicting results. We therefore performed a meta-analysis of all available randomized trials to compare the relative clinical efficacy and safety of ZES versus SES in patients with coronary artery disease (CAD).
Methods: The published literature was scanned by formal searches of electronic databases such as PubMed and conference proceedings from January 2001 to April 2010. All randomized trials comparing ZESs versus SESs 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 5 randomized trials were included in the meta-analysis, involving 5,421 patients (2,815 randomized to ZES and 2,606 randomized to SES). At a mid-term (9–12 months) follow-up, no significant difference was observed in rates of all-cause death (1.7% for ZES vs. 1.5% for SES, OR 1.23, 95% confidence interval [CI] 0.80–1.89, P = 0.36), cardiac death (0.8% vs. 0.7%, OR 1.22, 95% CI 0.61–2.44, P = 0.58), myocardial infarction (2.8% vs. 3.0%, OR 0.87, 95% CI 0.36–2.09, P = 0.76), or definite stent thrombosis (0.7% vs. 0.4%, OR 1.38, 95% CI 0.29–6.47, P = 0.69), whereas ZESs were associated with a significant increase in ischemia-driven target lesion revascularization (6.4% vs. 2.4%, OR 2.75, 95% CI 1.91–3.95, P < 0.0001). At a long-term (> 1 year) follow-up, the relative risks of death or myocardial infarction and stent thrombosis were also similar between 2 groups (6.5% vs. 5.6%, OR 0.83, 95% CI 0.33–2.07, P = 0.69 for death or myocardial infarction; 1.0% vs. 0.7%, OR 1.20, 95% CI 0.46–3.11, P = 0.71 for definite stent thrombosis), and the rate of target lesion revascularization remained higher in the ZES group compared to the SES group (9.7% vs. 4.3%, OR 2.00, 95% CI 1.04–3.85, P = 0.04).
Conclusions: ZES is inferior to SES in reducing the incidence of TLR, with nonsignificant differences in terms of death, myocardial infarction and stent thrombosis.
- © 2010 by American Heart Association, Inc.