The efficacy of sirolimus- and paclitaxel-eluting stents: A meta-analysis of randomized controlled trials

Background: Drug-eluting stents prevent in-stent restenosis after percutaneous coronary intervention, and differences between sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) may exist in the rates of target lesion revascutarization, death, myocardial infarction and stent thrombosis. Objective: To compare the efficacy of SES and PES with the efficacy of bare-metal stents for de novo coronary lesions in patients with stable or unstable angina. Methods: A meta-analysis of randomized trials from MEDLINE, EMBASE and other electronic databases and conference proceedings was conducted. The efficacy of SES, PES with a polymer carrier (PPOL) and PES without a polymer carrier (PNPOL) was compared using random-effects models. Results: Ten trials comprising 5041 patients were included in the meta-analysis. There was an absolute decrease in target lesion revascularization of 17% (95% CI 14% to 20%), 9% (95% CI 6% to 11%) and 3% (95% CI 0% to 6%) with SES, PPOL and PNPOI, respectively, with significant difterences between SES and PPOL and between PPOL and PNPOL (P<0.01 for both comparisons). However, sensitivity analysis using the OR of target lesion revasculanzation showed no difference between SES (OR 0.18 [95% CI 0.12 to 0.26]) and PPOL (OR 0.25 [95% CI 0.16 to 0.37]) (P=0.26). There were no differences in the incidence of death, myocardial trifarction or stent thrombosis, although the small number of events limited the power of these analyses. Conclusions: SES show a greater absolute reduction in target lesion revascutarization than do PES, likely due to differences in the bare-metal stents used for comparison in the trials. Head-to-head comparisons are needed to directly address the differential efficacy of SES and PES.