Clinical InvestigationInterventional CardiologySafety and efficacy of everolimus- versus sirolimus-eluting stents: A systematic review and meta-analysis of 11 randomized trials
Section snippets
Search strategy, data extraction, and bias assessment
We included in our analysis all reported randomized controlled trials (RCT) that compared EES (Xience V [Abbott Vascular, Santa Clara, California] and Promus [Boston Scientific, Natick, Massachusetts]) with SES (Cypher, Cordis Coporation, Bridgewater, New Jersey) in patients with coronary artery disease.
We performed an electronic search of the United States National Library of Medicine (PubMed, at www.pubmed.gov), the United States National Institutes of Health clinical trials registry (//www.clinicaltrials.gov
Results
As shown in Figure 1, this meta-analysis finally included 11 RCTs,2, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 1 of which has been presented at meetings, but not published in its full form.24 Among a total of 12,869 patients that were studied, 6,894 (53.6%) were allocated to receive EES, and 5,975 (46.4%) to SES. The inter-observer agreement for study selection was high with к = 0.98.
The main characteristics of individual studies are summarized in the Table. The follow-up period ranged from 6 to
Discussion
Whether advanced generation DES are superior to selected first generation DES is uncertain, and comparative trials have demonstrated inconsistent results. In the most comprehensive meta-analysis of comparative EES versus SES trials, EES significantly reduced the risk of repeat revascularization compared to SES, which in turn led to a tendency toward a lower risk of MACE. We found no significant differences in the risk of cardiac death or MI between the use of EES and SES. However, the rate of
Conclusions
In this meta-analysis of 11 randomized trials, the use of EES compared to SES was shown to reduce the risk for repeat revascularization and the risk of definite ST. We found no significant differences in the risk of cardiac death or MI, while definite or probable ST tended to occur in a decreased rate with marginal significance. Future studies and analyses with longer duration of follow-up are needed to confirm our results in the long-term perspectives.
Disclosures
The authors have no potential financial conflicts on this subject.
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The first two authors contributed equally to the study.