Abstract 15180: Impact of the Everolimus-Eluting Stent on Stent Thrombosis According to Baseline Risk of Study Population
Purpose Several studies suggest lower risk for stent thrombosis (ST) with use of the 2nd generation everolimus-eluting stent (EES) compared to non everolimus-eluting drug eluting stents (EE-DES). Whether or not these benefits are uniform across all patient populations remains unknown.
Methods We conducted a meta-analysis of all randomized studies comparing the EES to non EE-DES. ST was classified as definite or probable by the academic research consortium (ARC) criteria. Baseline risk for ST was defined as the cumulative ST rate in the non EE-DES group in each study. The association between baseline ST risk and the absolute risk difference in ST between groups was assessed using weighted linear regression.
Results We identified thirteen randomized trials (n=17,074) comparing the frequency of ST between the EES (n=9737) and the non EE-DES (n=7337). Comparator DES included the paclitaxel (n=4), sirolimus (n=7) and zotarlimus (n=1) eluting stents, respectively. Over a mean follow-up of 21 months the incidence of ST was significantly lower with the EES compared to the non EE-DES (0.7% vs. 1.5%, RR 0.55; 95% CI: 0.38 - 0.78). The absolute benefit of the EES increased in a dose dependent fashion with greater baseline risk in the control population (R2 = 0.89, p<0.001, Figure). Risk reductions were greatest in studies using the paclitaxel-eluting stent, indermediate against zotarlimus-eluting stent and smallest against the sirolimus-eluting stent.
Conclusions The EES is associated with a large and significant reduction in ST compared to non EE-DES with greater benefit in populations at higher risk for ST.
- © 2011 by American Heart Association, Inc.