Head-to-head comparison of sirolimus-eluting stents versus paclitaxel-eluting stents in patients undergoing percutaneous coronary intervention: a meta-analysis of 76 studies

Xinlin Zhang; Jun Xie; Guannan Li; Qinhua Chen; Biao Xu

doi:10.1371/journal.pone.0097934

Head-to-head comparison of sirolimus-eluting stents versus paclitaxel-eluting stents in patients undergoing percutaneous coronary intervention: a meta-analysis of 76 studies

PLoS One. 2014 May 20;9(5):e97934. doi: 10.1371/journal.pone.0097934. eCollection 2014.

Authors

Xinlin Zhang¹, Jun Xie¹, Guannan Li¹, Qinhua Chen¹, Biao Xu¹

Affiliation

¹ Department of Cardiology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.

Abstract

Background: The relative short-, long- and overall-term efficacy and safety of sirolimus-eluting stents (SES, Cypher) compared with paclitaxel-eluting stents (PES, Taxus) in large head-to-head comparisons still remain to be defined.

Methods: We searched Pubmed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) for articles comparing outcomes of interest between SES and PES without language restriction. Short- (≤ 1 year), long- (>1 year), and overall-term (the longest follow-up of each study) outcomes were evaluated. The primary endpoint was target lesion revascularization (TLR). Other outcomes of interest were target vessel revascularization (TVR), myocardial infarction, all-cause death, cardiac death, stent thrombosis, major adverse cardiac events (MACEs), restenosis and late lumen loss.

Results: Seventy-six studies including more than 15000 patients in randomized controlled trials and over 70000 patients in adjusted observational studies were included. At overall-term follow-up, SES significantly reduced TLR (relative risk [RR]: 0.61; 95% confidence interval [CI]: 0.49-0.76), TVR (RR: 0.67; 95% CI: 0.54-0.83), MACE (RR: 0.79; 95% CI: 0.72-0.87), myocardial infarction (RR: 0.85; 95% CI: 0.73-0.99), in-segment restenosis (RR: 0.50; 95% CI: 0.38-0.65), and in-segment late lumen loss (weighted mean difference [WMD]: -0.19; 95% CI: -0.24--0.14) in randomized controlled trials compared with PES. In addition, lower rates of death (RR: 0.91; 95% CI: 0.83-1.00), any stent thrombosis (RR: 0.62; 95% CI: 0.45-0.86), definite stent thrombosis (RR: 0.59; 95% CI: 0.45-0.77) were found in patients receiving SES in adjusted observational studies. Largely similar results were found at short- and long-term follow-up, and in patients with diabetes, acute myocardial infarction or long lesions.

Conclusions: SES significantly reduced the short-, long- and overall-term risk of TLR/TVR, MACE, and restenosis, and overall-term risk of myocardial infarction in randomized controlled trials, as compared with PES. Lower rates of death and stent thrombosis were also observed in observational studies in SES-treated patients.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Cause of Death
Coronary Artery Disease / mortality
Coronary Artery Disease / therapy
Drug-Eluting Stents* / adverse effects
Humans
Observational Studies as Topic
Odds Ratio
Paclitaxel / administration & dosage*
Percutaneous Coronary Intervention* / adverse effects
Randomized Controlled Trials as Topic
Sirolimus / administration & dosage*
Treatment Outcome

Substances

Paclitaxel
Sirolimus

Grants and funding

This work was supported by grants from the National Natural Science Foundation of China (research grants 81070195, 81270281 and 81200148), Jiangsu Key Laboratory for Molecular Medicine of Nanjing University (research grant 2008), and Funds for Distinguished Young Scientists in Nanjing (Xie Jun). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.