Author + information
- Received April 29, 2011
- Revision received June 20, 2011
- Accepted June 28, 2011
- Published online October 4, 2011.
- Usman Baber, MD, MS⁎,
- Roxana Mehran, MD⁎,
- Samin K. Sharma, MD⁎,
- Somjot Brar, MD, MPH†,
- Jennifer Yu, MD⁎,
- Jung-Won Suh, MD, PhD‡,
- Hyo-Soo Kim, MD, PhD‡,
- Seung-Jung Park, MD, PhD§,
- Adnan Kastrati, MD∥,
- Antoinette de Waha, MD∥,
- Prakash Krishnan, MD⁎,
- Pedro Moreno, MD⁎,
- Joseph Sweeny, MD⁎,
- Michael C. Kim, MD⁎,
- Javed Suleman, MD⁎,
- Robert Pyo, MD⁎,
- Jose Wiley, MD⁎,
- Jason Kovacic, MD, PhD⁎,
- Annapoorna S. Kini, MD⁎ and
- George D. Dangas, MD, PhD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. George D. Dangas, Mount Sinai School of Medicine, Zena and Michael A. Weiner Cardiovascular Institute, 1190 Fifth Avenue–1 South, New York, New York 10029
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 (R2 = 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.
Dr. Mehran has received institutional research grant support from Bristol-Myers Squibb/Sanofi-Aventis and The Medicines Company; and has consulting agreements with Abbott Vascular, AstraZeneca, Regado Biosciences, and OrthoMcNeil. Dr. Sharma has received honoraria for lectures from Abbott Vascular, Boston Scientific, Daiichi Sankyo, Inc., Eli Lilly Company, and The Medicines Company. Dr. Kastrati has received lecture fees from Abbott Vascular, Biosensors, Biotronik, Cordis, and Medtronic. Dr. Moreno has served as an expert witness for Abbott Vascular. Dr. Sweeny is a consultant for Gilead. Dr. Suleman is a speaker for and receives honorarium from Eli Lilly/Daiichi Sankyo. Dr. Dangas has received institutional research grant support from Bristol-Myers Squibb/Sanofi-Aventis and The Medicines Company; consulting agreements with Abbott Vascular, AstraZeneca, Regado Biosciences, and OrthoMcNeil; and is a clinical study investigator for Medtronic.
All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 29, 2011.
- Revision received June 20, 2011.
- Accepted June 28, 2011.
- American College of Cardiology Foundation