Abstract 17806: Clinical Outcomes of Patients Treated With First Generation vs. Second Generation Drug-eluting Stents for Left Main Coronary Artery Disease: A Meta-analysis
Introduction: The second generation drug-eluting stents Everolimus and/or Zotarolimus (S-DES) have been proven to be superior to the first generation drug-eluting stents Sirolimus and/or Paclitaxel (F-DES) when treating non-left main coronary artery lesions. Previous studies have come to inconsistent results regarding the efficacy of these two stent types in patients treated for left main coronary artery disease (LMCAD).
Hypothesis: We hypothesized that the use of S-DES would results in better outcomes than F-DES in patients with LMCAD.
Methods: We performed a meta-analysis to summarize the up-to-date evidence on this subject. We included studies comparing clinical outcomes for S-DES vs F-DES in patients with LMCAD. We examined the following end-points: Mortality, myocardial infarction (MI), and target-vessel revascularization (TVR). In addition we examined the rates of stent thrombosis and major adverse cardiac events (MACE). MACE was defined according to the definition used by each of the included studies. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated for all the clinical outcomes using a random-effect model.
Results: A total of 4 studies met our search criteria and were included in the analysis. Among these studies 701 patients were treated with F-DES and 753 patients were treated with S-DES. There was no significant difference in all-cause mortality or MI in the group of patients treated with S-DES as compared with those treated with F-DES. TVR was lower with S-DES. (Figure 1). In addition, S-DES was associated with lower MACE rates (RR: 0.63; 95% CI: 0.48 to 0.82; p <0.05) and there was a trend toward a lower rate of stent thrombosis (RR: 0.40; 95% CI: 0.13 to 1.20; p 0.10) with S-DES.
Conclusions: The use of S-DES for the treatment of LMCAD is associated with improved clinical outcomes as compared with F-DES. S-DES should be the stents of choice when treating patients with LMCAD.
Author Disclosures: C.A. Gongora: None. A. Casso Dominguez: None. C. Bavishi: None. J. Pena: None. P. Chavez: None. S. Arora: None. P. Moreno: Honoraria; Modest; AstraZeneca. J. Tamis-Holland: None.
- © 2015 by American Heart Association, Inc.