TY - JOUR
T1 - Adjusted indirect comparison of intracoronary drug-eluting stents
T2 - Evidence from a metaanalysis of randomized bare-metal-stent-controlled trials
AU - Biondi-Zoccai, Giuseppe G L
AU - Agostoni, Pierfrancesco
AU - Abbate, Antonio
AU - Testa, Luca
AU - Burzotta, Francesco
AU - Lotrionte, Marzia
AU - Crea, Filippo
AU - Biasucci, Luigi M.
AU - Vetrovec, George W.
AU - Colombo, Antonio
PY - 2005/4/8
Y1 - 2005/4/8
N2 - 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.
AB - 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.
KW - Drug-eluting stents
KW - Metaanalysis
KW - Stents
UR - http://www.scopus.com/inward/record.url?scp=20144389227&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=20144389227&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2004.11.001
DO - 10.1016/j.ijcard.2004.11.001
M3 - Article
C2 - 15820294
AN - SCOPUS:20144389227
VL - 100
SP - 119
EP - 123
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
IS - 1
ER -