Sirolimus- versus paclitaxel-eluting stents for coronary bifurcations intervention (original) (raw)

2012, Catheterization and Cardiovascular Interventions

Backgrounds: Relative efficacy and safety of sirolimus-eluting stents (SES) compared with paclitaxel-eluting stents (PES) remains controversial. It is unknown whether there are different effect and safety in coronary bifurcation treatment between SES and PES. Objectives: The meta-analysis was performed to compare the clinical outcomes of SES and PES in coronary bifurcation intervention. Methods: Five head-to-head clinical trials of SES versus PES in coronary bifurcation intervention were included. A total of 2,567 patients were involved in the meta-analysis. Mean follow-up period ranged from 6 to 35 months. The primary end points were the need for target lesion revascularization (TLR) and main-branch restenosis. Secondary end points were target vessel revascularization (TVR), cardiac death, major adverse cardiac events (MACE), and stent thrombosis. Results: Compared with PES, SES significantly reduced the risk of TLR (5.3% vs. 10.6%, odds ratio (OR) 0.52; 95% confidence interval (CI) 5 0.38-0.70, P < 0.001), main-branch restenosis (4.59% vs. 12.59%, OR 0.31; 95% CI 5 0.18-0.55, P < 0.001) and TVR (7.05% vs. 12.57%, OR 0.58; 95% CI 5 0.42-0.81, P 5 0.001) in coronary bifurcation intervention. In addition, SES group also had a significantly lower incidence of MACE (8.20% vs. 14.13%, OR 0.58; 95% CI 5 0.40-0.84, P 5 0.004) than PES group. However, there were no statistical difference with respect to the incidence of cardiac death (1.64% vs. 1.09%, P 5 0.19) and stent thrombosis (0.84% vs. 1.08%, P 5 0.64) between SES and PES groups. Conclusions: Compared with PES, SES reduced the incidence of TLR, mainbranch restenosis and MACE in coronary bifurcation intervention, while the risk of stent thrombosis was similar between SES and PES groups. V C 2011 Wiley-Liss, Inc.