Journal of Thrombosis and Thrombolysis

, Volume 38, Issue 3, pp 355–363

Sirolimus-eluting versus paclitaxel-eluting stent in primary angioplasty: a pooled patient-level meta-analysis of randomized trials

  • Giuseppe De Luca
  • Jeffrey Wirianta
  • Jae-Hwan Lee
  • Christoph Kaiser
  • Emilio Di Lorenzo
  • Harry Suryapranata
Article

DOI: 10.1007/s11239-014-1052-y

Cite this article as:
De Luca, G., Wirianta, J., Lee, JH. et al. J Thromb Thrombolysis (2014) 38: 355. doi:10.1007/s11239-014-1052-y
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Abstract

Large interests have been focused on the role of drug-eluting stents in the setting of ST-segment elevation myocardial infarction (STEMI) and concerns have emerged regarding an higher risk of stent thrombosis. Aim of the current study was to perform a meta-analysis using individual patient data to evaluate the long-term safety and effectiveness of sirolimus-eluting stent (SES) as compared to paclitaxel-eluting stent (PES) in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI. The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL). We examined all completed randomized trials of SES versus PES for STEMI. No language restriction was applied. Primary study endpoint was the occurrence of major adverse cardiac events (MACE). Secondary endpoints were the occurrence of death, reinfarction, stent thrombosis, target-vessel revascularization (TVR). Individual patient data were obtained from 4 out of 5 trials identified, including a total of 1,000 patients, 504 (50.4 %) randomized to SES and 496 (49.6 %) randomized to PES. At long-term follow-up (1,021 [372–1,351] days), no difference was observed between SES and PES in terms of TVR (10 vs 11.6 %, HR [95 % CI 0.73 [0.45–1.16], p = 0.18, p het = 0.92]) (primary endpoint) or death (9.4 vs 10.4 %, HR [95 % CI 0.95 [0.58–1.54], p = 0.82, p het = 0.89]), reinfarction (8.2 vs 10.4 %, HR [95 % CI 0.91 [0.53–1.57], p = 0.73, p het = 0.83]), stent thrombosis (7.4 vs 4.6 %, HR [95 % CI 1.04 [0.55–2.05], p = 0.92, p het = 0.65]), and MACE (10 vs 13.6 %, HR [95 % CI 0.86 [0.63–1.18], p = 0.36, p het = 0.84]) (secondary endpoints). The present pooled patient-level meta-analysis demonstrates that, among STEMI patients undergoing primary PCI, SES and PES are associated with a similar outcome at long-term follow-up, in terms of death, reinfarction, stent thrombosis, TVR and MACE.

Keywords

Primary angioplastySTEMIDrug eluting stentMeta-analysisRandomized trialsSirolimusPaclitaxel

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Giuseppe De Luca
    • 1
    • 2
  • Jeffrey Wirianta
    • 3
  • Jae-Hwan Lee
    • 4
  • Christoph Kaiser
    • 5
  • Emilio Di Lorenzo
    • 6
  • Harry Suryapranata
    • 7
  1. 1.Division of Cardiology, Ospedale “Maggiore Della Carità”Eastern Piedmont UniversityNovaraItaly
  2. 2.Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA)Eastern Piedmont UniversityNovaraItaly
  3. 3.Cardiovascular Center CinereJakartaIndonesia
  4. 4.Cardiovascular Center in Chungnam National University HospitalChungnam National UniversityDaejeonKorea
  5. 5.Department of CardiologyUniversity Hospital BaselBaselSwitzerland
  6. 6.Division of CardiologyS.G. MoscatiAvellinoItaly
  7. 7.Department of CardiologyUMC St RadboudNijmegenThe Netherlands