Abstract 21257: Everolimus Eluting Stents Are Safer and Efficacious Than Paclitaxel Eluting Stents in Coronary Artery Disease
Background: The use of second generation Everolimus Eluting Stents (EES) has been increasing lately and is becoming standard of care. The available evidence demonstrated angiographic superiority of EES over the first generation drug eluting stents. However, evidence comparing the EES with Paclitaxel Eluting Stents (PES) for clinical end points is inconclusive. We, therefore, conducted a meta analysis of current evidence to evaluate safety and efficacy of EES versus PES.
Materials and Methods: A systematic review of literature revealed four randomized trials with a total of 6686 patients. The clinical end points included are listed below. Data were extracted on intention to treat basis. Cochran's Q statistics analyzed the heterogeneity of the studies. The studies were homogenic for each outcome; therefore the Mantel-Haenszel fixed-effect model was used to calculate combined relative risks (RR). A two-sided alpha error of <0.05 was considered to be statistically significant.
Results: Both groups had similar baseline characteristics. The end points looked at were − 1) ischemia driven target lesion failure (TLF), 2) major adverse cardiovascular events (MACE), 3) ischemia driven target vessel revascularization (TVR), 4) ischemia driven TLR and 5) stent thrombosis rates at the end of one year. The EES group had significantly lower one year relative risk of ischemia driven TLF, TVR, TLR and MACE (p<0.00001) when compared to PES group. Similarly, the 1 yr stent thrombosis rates were significantly lower in EES (p=0.0002) when compared to PES group. A subgroup analysis of MACE in patients with Diabetes mellitus revealed no benefit of EES over PES. (RR: 1.05, CI: 0.75–1.47; p−0.75).
Conclusion: In conclusion, our meta analysis demonstrates a significant benefit of EES over PES in efficacy and thrombotic end points at one year for elective PCI. Larger randomized trials are needed to evaluate the efficacy of EES in other groups of patients like Diabetics, Acute coronary syndromes.
- © 2010 by American Heart Association, Inc.