Impact of the Everolimus-Eluting Stent on Stent Thrombosis A Meta-Analysis of 13 Randomized Trials

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:58

Article

Brar, Somjot²  Suh, Jung-Won³  Kim, Hyo-Soo³  Park, Seung-Jung⁴  Kastrati, Adnan⁵  de Waha, Antoinette⁵  Dangas, George D.¹ 

[1] Mt Sinai Sch Med, Zena & Michael Weiner Cardiovasc Inst, New York, NY 10029 USA

[2] Kaiser Permanente, Pasadena, CA USA

[3] Seoul Natl Univ Hosp, Seoul 110744, South Korea

[4] Asan Med Ctr, Seoul, South Korea

[5] Tech Univ Munich, Deutsch Herzzentrum, Munich, Germany

关键词: drug-eluting stent;    everolimus-eluting;    stent thrombosis;   

DOI  :  10.1016/j.jacc.2011.06.049

来源: Elsevier

【 摘 要 】

Objectives We evaluated the impact of the everolimus-eluting stent (EES) on the frequency of stent thrombosis (ST), target vessel revascularization (TVR), myocardial infarction (MI), and cardiac death in randomized controlled trials comparing the EES to non-everolimus-eluting drug-eluting stents (EE-DES). Background Whether or not the unique properties of the EES translate into reductions in ST remains unknown. Methods We searched MEDLINE, Scopus, the Cochrane Library, and Internet sources for articles comparing outcomes between EES and non-EE-DES without language or date restriction. Randomized controlled trials reporting the frequency of ST were included. Variables relating to patient and study characteristics and clinical endpoints were extracted. Results We identified 13 randomized trials (n = 17,101) with a weighted mean follow-up of 21.7 months. Compared with non-EE-DES, the EES significantly reduced ST (relative risk [RR]: 0.55; 95% confidence interval [CI]: 0.38 to 0.78; p = 0.001), TVR (RR: 0.77; 95% CI: 0.64 to 0.92; p = 0.004), and MI (RR: 0.78; 95% CI: 0.64 to 0.96; p = 0.02). There was no difference in cardiac mortality between the groups (RR: 0.92; 95% CI: 0.74 to 1.16; p = 0.38). The treatment effect was consistent by different follow-up times and duration of clopidogrel use. The treatment effects increased with higher baseline risks of the respective control groups with the strongest correlation observed for ST (R-2 = 0.89, p < 0.001). Conclusions Intracoronary implantation of the EES is associated with highly significant reductions in ST with concordant reductions in TVR and MI compared to non-EE-DES. Whether these effects apply to different patient subgroups and DES types merits further investigation. (J Am Coll Cardiol 2011; 58: 1569-77) (C) 2011 by the American College of Cardiology Foundation

【 授权许可】

Free