Adjusted indirect comparison of intracoronary drug-eluting stents: Evidence from a metaanalysis of randomized bare-metal-stent-controlled trials

Giuseppe G L Biondi-Zoccai, Pierfrancesco Agostoni, Antonio Abbate, Luca Testa, Francesco Burzotta, Marzia Lotrionte, Filippo Crea, Luigi M. Biasucci, George W. Vetrovec, Antonio Colombo

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: Drug-eluting stents (DES) have been recently investigated, with favorable data for many devices, but comparative data are lacking. We thus performed an adjusted indirect comparison metaanalysis of DES. Methods: Randomized trials comparing DES vs. bare-metal stents (BMS) were systematically searched, and random effect odds ratios (OR) were computed for target lesion revascularization (TLR) and binary in-stent restenosis rate (BRR) at 6-12 months. We then generated interaction OR for the comparison of different DES. Results: We pooled data from 17 studies (allocating 3048 patients to BMS and 3392 to nine different DES). Indirect head-to-head comparison of sirolimus-eluting Cypher (N=1007) vs. polymeric paclitaxel-eluting Taxus (N=959) showed nonsignificant differences in TLR [OR=0.8 (0.5-1.4), p=0.45] but significant reductions in BRR favoring Cypher [OR=0.3 (0.1-0.6), p0.50 for both TLR and BRR). Actinomycin-, mycophenolate-, and apolymeric paclitaxel-eluting stents (PES) all proved significantly worse than Cypher or Taxus for TLR or BRR. Conclusion: Notwithstanding its inherent limitations, the present metaanalysis confirms the effectiveness of both Cypher and Taxus, supports the promising role of everolimus-eluting stents, and suggests the significant inferiority of most other devices. These post hoc findings, albeit intriguing, await prospective confirmation.

Original languageEnglish
Pages (from-to)119-123
Number of pages5
JournalInternational Journal of Cardiology
Volume100
Issue number1
DOIs
Publication statusPublished - Apr 8 2005

Keywords

  • Drug-eluting stents
  • Metaanalysis
  • Stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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