Everolimus-Eluting versus Paclitaxel-Eluting Stents in Percutaneous Coronary Intervention: Meta-Analysis of Randomized Trials

Alazzoni, Ashraf; Al-Saleh, Ayman; Jolly, Sanjit S.

doi:10.1155/2012/126369

Cited by 24 publications

(13 citation statements)

References 18 publications

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“…A comprehensive network meta-analysis by Palmerini T et al [25], in which 50,844 patients with unclassified coronary heart diseases were enrolled, showed that the second-generation DES, EES but not ZES, had the lower rate of stent thrombosis within 2 years of implantation than bare-metal stents and first-generation DES. The beneficial effect of EES was also confirmed by another small-scale meta-analysis performed by Alazzoni A et al [26]. However, another meta-analysis of 19 trials including 16,924 unrestricted coronary artery disease subjects did not find the differences in stent thrombosis between the overall second-generation DES and the overall first-generation those during the first year after stent implantation [27].…”

Section: Discussionmentioning

confidence: 74%

Drug-Eluting Stents for Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials

Wang

Zang²,

Xie³

et al. 2013

PLoS ONE

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BackgroundDrug-eluting stents (DES) are increasingly used for treatment of acute coronary syndrome (ACS). However, clinical efficacy and safety of various types of DES is not well established in these subjects. We therefore evaluated clinical utility of second-generation and first-generation DES in patients with ACS by conducting a meta-analysis.MethodsA search of Medline, Embase, the Cochrane databases, and Web of Science was made. Randomized controlled trials (RCTs) which compared second-generation DES (everolimus-eluting stents [EES] or zotarolimus-eluting stents [ZES]) versus first-generation DES (sirolimus-eluting stents [SES] or paclitaxe-eluting stents [PES]) in patients with ACS and provided data on clinical efficacy or safety endpoints were included. Pooled estimates were calculated using random-effects model.ResultA total of 2,757 participants with ACS in 6 RCTs were included. Compared with first-generation one, second-generation DES trended to be associated with the decreased incidence of definite or probable stent thrombosis in ACS patients (risk ratio [RR] = 0.60, 95% confidence intervals [CI] 0.33 to 1.07, p = 0.09). However, the rate of target lesion revascularization (TLR) significantly increased in second-generation DES (RR = 2.08, 95%CI 1.25 to 3.47, p = 0.005). There were no significant differences in the incidence of major adverse cardiac events (MACEs), all-cause death, cardiac death, and recurrent myocardial infarction between the two arms (all p>0.10). The second-generation EES showed a tendency towards lower risk of MACEs (p = 0.06) and a beneficial effect on reducing stent thrombosis episodes (p = 0.009), while the second-generation ZES presented an increased occurrence of MACEs (p = 0.02) and TLR (p = 0.003).ConclusionSecond-generation DES, especially EES, appeared to present a lower risk of stent thrombosis, whereas second-generation ZES might increase the need for repeat revascularization in ACS patients. During coronary interventional therapy, DES class should be adequately considered in order to maximize clinical benefit of DES implantation in these specific subjects.

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Section: Discussionmentioning

confidence: 74%

Drug-Eluting Stents for Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials

Wang

Zang²,

Xie³

et al. 2013

PLoS ONE

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“…16 Binary restenosis rates at follow-up showed that patients who presented with anginal symptoms were significantly low in limus group than in the paclitaxel group which is similar to the studies conducted in the past. [17][18][19][20] No deaths or MI were reported at follow-up. Target lesion revascularization, target vessel revascularization, and target vessel failure rates were similar between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Clinical and angiographic profile of symptomatic patients undergoing percutaneous transluminal coronary angioplasty and drug-eluting stent implantation

Bhupal

Kumar

2019

Int J Res Med Sci

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Background: There are limited number of studies in India which have looked at this clinical and angiographic characteristic of the disease. Thus, this study was conducted to assess the clinical and angiographic profile of symptomatic patients who underwent percutaneous transluminal coronary angioplasty (PTCA) and drug-eluting stent (DES) implantation.Methods: This was an observational study conducted at a tertiary-care center in India between November 2014 and November 2015. A total of 106 consecutive patients who received either Cypher/Xience/BioMime stent presented with anginal symptoms were included in the study. Based on the type of stent received, patients were divided into two groups: (A) Limus group; (B) Paclitaxel group. Coronary angiogram was done in all the patients. Angioplasty data were collected from patient records. Angiographic profiles of the two groups were compared and analysed.Results: Among the 106 patients, 54 patients were included in the Limus group and 52 patients were included in the Taxus stent. De novo lesions were found to be significantly higher in the Limus group (40(74%), p = 0.06) whereas the in-stent restenosis was found to be significantly higher in the paclitaxel group (22(42.3%), p = 0.08). At follow-up, the incidence of death was 0% and no patients suffered by myocardial infarction. One (1.8%), two (3.8%) patients from the Limus and Paclitaxel groups had target vessel revascularization, respectively.Conclusions: Development of lesions in new areas rather than in-stent restenosis is the cause for angina in the majority of patients who underwent angioplasty presenting with anginal symptoms.

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“…EES have been found to be superior to PES [ 11 , 27 – 29 ] and comparable to SES [ 30 , 31 ] with respect to cardiac death, MI, stent thrombosis, and revascularization in randomized trials and prospective cohort studies of general populations. ZES have also been found to be superior to PES [ 15 , 32 ] and comparable to SES [ 32 , 33 ] with respect to death rate and MI in randomized trials of general populations.…”

Section: Discussionmentioning

confidence: 99%

“…Sirolimus-eluting and paclitaxel-eluting stents (SES and PES), hereafter referred to as first-generation DES, are superior to BMS with respect to the in-stent restenosis rate and target lesion revascularization after CTO PCI [ 7 – 10 ]. However, everolimus-eluting and zotarolimus-eluting stents (EES and ZES), hereafter referred to as second-generation DES, have been found to be superior or comparable to first-generation DES for composite outcomes in non-CTO lesions [ 11 – 15 ]. In the context of CTO, a few studies have compared the impacts of second-generation DES on clinical outcomes with those of first-generation DES.…”

Section: Introductionmentioning

confidence: 99%

First-Generation Versus Second-Generation Drug-Eluting Stents in Coronary Chronic Total Occlusions: Two-Year Results of a Multicenter Registry

Ahn

Yang

et al. 2016

PLoS ONE

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BackgroundLimited data are available regarding the long-term clinical outcomes of second-generation drug-eluting stents (DES) versus first-generation DES in patients with coronary chronic total occlusion (CTO) who undergo percutaneous coronary intervention (PCI). The aim of this study was to compare the clinical outcomes of second-generation DES with those of first-generation DES for the treatment of CTO.Methods and ResultsBetween March 2003 and February 2012, 1,006 consecutive patients with CTO who underwent successful PCI using either first-generation DES (n = 557) or second-generation DES (n = 449) were enrolled in a multicenter, observational registry. Propensity-score matching was also performed. The primary outcome was cardiac death over a 2-year follow-up period. No significant differences were observed between the two groups regarding the incidence of cardiac death (first-generation DES versus second-generation DES; 2.5% vs 2.0%; hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.37 to 1.98; p = 0.72) or major adverse cardiac events (MACE, 11.8% vs 11.4%; HR: 1.00; 95% CI: 0.67 to 1.50; p = 0.99). After propensity score matching, the incidences of cardiac death (HR: 0.86; 95% CI: 0.35 to 2.06; p = 0.86) and MACE (HR: 0.93; 95% CI: 0.63 to 1.37; p = 0.71) were still similar in both groups. Furthermore, no significant differences were observed between sirolimus-eluting, paclitaxel-eluting, zotarolimus-eluting, and everolimus-eluting stents regarding the incidence of cardiac death or MACE.ConclusionThis study shows that the efficacy of second-generation DES is comparable to that of first-generation DES for treatment of CTO over 2 years of follow-up.

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Everolimus-Eluting versus Paclitaxel-Eluting Stents in Percutaneous Coronary Intervention: Meta-Analysis of Randomized Trials

Cited by 24 publications

References 18 publications

Drug-Eluting Stents for Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials

Drug-Eluting Stents for Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials

Clinical and angiographic profile of symptomatic patients undergoing percutaneous transluminal coronary angioplasty and drug-eluting stent implantation

First-Generation Versus Second-Generation Drug-Eluting Stents in Coronary Chronic Total Occlusions: Two-Year Results of a Multicenter Registry

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