Impact of the everolimus-eluting stent on stent thrombosis: A meta-analysis of 13 randomized trials

Usman Baber, Roxana Mehran, Samin K. Sharma, Somjot Brar, Jennifer Yu, Jung Won Suh, Hyo Soo Kim, Seung Jung Park, Adnan Kastrati, Antoinette De Waha, Prakash Krishnan, Pedro Moreno, Joseph Sweeny, Michael C. Kim, Javed Suleman, Robert Pyo, Jose Wiley, Jason Kovacic, Annapoorna S. Kini, George D. Dangas

Research output: Contribution to journalArticle

225 Scopus citations

Abstract

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 noneverolimus-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 nonEE-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 nonEE-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 nonEE-DES. Whether these effects apply to different patient subgroups and DES types merits further investigation.

Original languageEnglish (US)
Pages (from-to)1569-1577
Number of pages9
JournalJournal of the American College of Cardiology
Volume58
Issue number15
DOIs
StatePublished - Oct 4 2011

Keywords

  • drug-eluting stent
  • everolimus-eluting
  • stent thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Baber, U., Mehran, R., Sharma, S. K., Brar, S., Yu, J., Suh, J. W., Kim, H. S., Park, S. J., Kastrati, A., De Waha, A., Krishnan, P., Moreno, P., Sweeny, J., Kim, M. C., Suleman, J., Pyo, R., Wiley, J., Kovacic, J., Kini, A. S., & Dangas, G. D. (2011). Impact of the everolimus-eluting stent on stent thrombosis: A meta-analysis of 13 randomized trials. Journal of the American College of Cardiology, 58(15), 1569-1577. https://doi.org/10.1016/j.jacc.2011.06.049