1.
Long time clinical outcomes of limus-eluting stent versus paclitaxel-eluting stent in patients undergoing percutaneous coronary artery intervention: A meta-analysis of randomized controlled clinical trials.
Gao, L, Hu, X, Hou, Y, Xue, Q
Cardiology journal. 2014;(3):211-9
Abstract
BACKGROUND The meta-analysis was aimed to compare the long time (> 2 year) clinical outcomes of limus-based stents (LBS) and paclitaxel-eluting stents (PES). LBS and PES are two kinds of most common coronary artery stents in clinics. METHODS Electronic data bases of PubMed, Cochrane, and EMBASE were searched. We included randomized controlled clinical trials (RCT) comparing LBS and PES with long time clinical outcomes. Methodological quality of eligible trials was assessed using "risk of bias" tool. The efficacy endpoints included target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis (ST), and the safety endpoints included all cause death, cardiac death, and myocardial infarction (MI). Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated for each endpoint. RESULTS A total of 23 RCTs and 19,319 participants were included and analyzed in this meta-analysis. All trials were of an acceptable quality. At 2 years, LBS showed reduced risk of revascularization and ST (TLR: OR = 0.59, 95% CI 0.44-0.78; TVR: OR = 0.63, 95% CI 0.55-0.71; ST: OR = 0.55, 95% CI 0.41-0.73) and a lower rate of MI (OR = 0.67, 95% CI 0.57-0.79). Subgroup analysis showed that both everolimus-eluting stents and sirolimus-eluting stents had better clinical outcomes compared with PES. The comparisons of 3, 4 and 5 year follow-up results revealed that the clinical outcomes of PES were non-inferior to those of LBS but LBS was associated with reduced risk of MI and ST at 3 years. CONCLUSIONS LBS is associated with better clinical outcomes at 2 years. Both LBS and PES showed similar efficacy and safety at long time period.
2.
Meta-analysis of five randomized clinical trials comparing sirolimus- versus paclitaxel-eluting stents in patients with diabetes mellitus.
Zhang, F, Dong, L, Ge, J
The American journal of cardiology. 2010;(1):64-8
Abstract
Recent data on drug-eluting stents have shown improved clinical outcomes in patients with diabetes mellitus. However, the relative efficacy and safety of sirolimus-eluting stents (SES) compared with paclitaxel-eluting stents (PES) remains controversial. Therefore, a meta-analysis of randomized trials was performed to compare SES with PES exclusively in patients with diabetes. The published research was scanned by formal searches of electronic databases (PubMed, EMBASE and the Cochrane Central Register of Controlled Trials) from January 2001 to April 2009. All randomized trials involving head-to-head comparison of SES versus PES in patients with diabetes were examined for analysis. A total of 5 randomized trials were included in the present meta-analysis, involving 1,173 patients (594 in the SES group, 579 in the PES group). SES were significantly more effective in the reduction of target lesion revascularization (5.1% vs 11.4%, odds ratio [OR] 0.41, 95% confidence interval [CI] 0.26 to 0.64, p <0.001) and angiographic binary (> or =50%) restenosis (5.6% vs 16.4%, OR 0.30, 95% CI 0.19 to 0.48, p <0.001) compared to PES. In contrast, the differences between SES and PES were not statistically significant with respect to cardiac death (2.2% vs 2.9%, OR 0.71, 95% CI 0.34 to 1.47, p = 0.35), myocardial infarction (1.5% vs 2.6%, OR 0.58, 95% CI 0.26 to 1.31, p = 0.19), and stent thrombosis (0.6% vs 1.2%, OR 0.57, 95% CI 0.18 to 0.84, p = 0.35). In conclusion, SES are superior to PES in reducing the incidences of restenosis and target lesion revascularization in patients with diabetes, with nonsignificant differences in terms of cardiac death, myocardial infarction, and stent thrombosis.
3.
Periprocedural and late consequences of overlapping Cypher sirolimus-eluting stents: pooled analysis of five clinical trials.
Kereiakes, DJ, Wang, H, Popma, JJ, Kuntz, RE, Donohoe, DJ, Schofer, J, Schampaert, E, Meier, B, Leon, MB, Moses, JW
Journal of the American College of Cardiology. 2006;(1):21-31
Abstract
OBJECTIVES The purpose of this research was to determine the relative safety and efficacy of multiple (> or =2) overlapping Cypher sirolimus-eluting stents (SES) (Johnson & Johnson, New Brunswick, New Jersey). BACKGROUND Overlapping coronary stents are common. The periprocedural and late clinical and angiographic consequences of overlapped coronary stents are not clearly defined, particularly for drug-eluting stents. METHODS All patients enrolled into five clinical trials of the SES were analyzed. Three of these trials were prospective randomized comparisons of the SES to the bare-metal stent (BMS), and two were prospective non-randomized trials of SES-treated patients with historical controls. All clinical and angiographic outcomes in overlap-stent-treated patients were compared by stent type and with single-stent-treated patients for the same stent device. RESULTS In all, 575 patients with stent overlap (337 SES, 238 BMS) and 1,162 patients with single stents (697 SES, 465 BMS) were analyzed. Stent overlap was associated with a greater late lumen loss in stent and more frequent angiographic restenosis regardless of stent type. Among overlap-stent-treated patients, the SES provided similar magnitude of restenosis benefit as observed for single-stent-treated patients. Overlapped SES was not associated with an increase in myocardial infarction. CONCLUSIONS The strategy of SES overlap, when required, is both safe and efficacious in reducing restenosis with no increase in the incidence of myocardial infarction or major adverse cardiovascular events, when compared with a bare metal coronary stent prosthesis.