Abstract 13527: Very Late Stent Thrombosis (1-2 Years) Comparison Between First and Second-Generation Drug-Eluting Stents. Meta-Analysis of 9 Studies Including 11,000 Patients.
Introduction: Recently published randomized clinical trials that compare first-generation (Cypher and Taxus) drug-eluting stents (DES) and second-generation DES (Xience, Endeavor, Biomatrix, and Nobori) haven't consistently demonstrated statiscally significant differences regarding the incidence of very late stent thrombosis (ST) between both stent types.
Objective: To analyze if there are statiscally significant differences between both DES types respecting very late ST, and to evaluate if there are differences between different second-generation DES types.
Materials and methods: Databases from Pubmed and the Cochrane Central Register of Controlled Trails were analyzed in search of randomized, multicenter, clinical trials in English that compared the incidence of ST between first and second-generation DES. 9 studies that included 11,000 patients were selected, of which 6,418 p received a second generation DES and 4,582 p a first generation DES. Definite and probable ST according to the definition of the Academic Research Consortium were included in the statistical analysis. Review Manager 5 was used for the statistical analysis.
Results: The incidence of very late ST was 0.24% in second-generation DES vs 0.74% in first-generation DES, OR 0.36 (0.2-0.66), p=0.0009 (Figure). This difference is fundamentally related with the results of the Compare, Spirit II, III, and IV trials, that compared Everolimus (second-generation DES) which had a ST of 0.23% (10/2403 patients) with Paclitaxel (first-generation DES) which had a ST of 0.76% (19/2491 patients), OR 0.33 (0.15-0.74), p=0.007.
Conclusions: The results of our meta-analysis confirm that first-generation DES present a significantly higher incidence of very late thrombosis (1-2 years) compared with second-generation DES. This major thrombosis incidence in first-generation stents is fundamentally based on the differences found in studies that compare Everolimus with Paclitaxel.
- © 2011 by American Heart Association, Inc.