Long-term clinical outcomes of everolimus-eluting stent versus paclitaxel-eluting stent in patients undergoing percutaneous coronary interventions: a meta-analysis

Abstract

Background: Everolimus -eluting stent (EES) is common used in patients undergoing percutaneous coronary interventions (PCI). Our purpose is to evaluate long-term clinical outcomes of everolimus -eluting stent (EES) versus paclitaxel-eluting stent (PES) in patients undergoing percutaneous coronaryinterventions (PCI) in randomized controlled trials (RCTs).

Methods: We searched Medline, EMBASE, Cochrane Library, CNKI, VIP and relevant websites ( https://scholar-google-com.ezproxy.lib.usf.edu/ ) for articles to compare outcomes between everolimus-eluting stent and paclitaxel-eluting stent without language or date restriction. RCTs that compared the use of everolimus -eluting stent and paclitaxel-eluting stent in PCI were included. Variables relating to patient, study characteristics, and clinical endpoints were extracted. Meta-analysis was performed using RevMan 5.2 software.

Results: We identified 6 published studies (from three randomized trials) more on everolimus-eluting stent (n = 3352) than paclitaxel-eluting (n = 1639), with follow-up duration ranging from 3, 4 and 5 years. Three-year outcomes of everolimus-eluting stent compared to paclitaxel-eluting were as following: the everolimus-eluting stent significantly reduced all-cause death (relative risk [RR]:0.63; 95% confidence interval [CI]: 0.46. to 0.82), MACE (RR: 0.56; 95% CI: 0.41 to 0.77), MI (RR: 0.64; 95% CI: 0.48 to 0.86), TLR (RR: 0.72; 95% CI: 0.59 to 0.88), ID-TLR (RR: 0.74; 95% CI: 0.59 to 0.92) and ST (RR: 0.54; 95% CI: 0.32 to 0.90). There was no difference in TVR between the everolimus-eluting and paclitaxel-eluting (RR: 0.76; 95% CI: 0.58 to 1.10); Four-year outcomes of everolimus-eluting compared to paclitaxel-eluting: the everolimus-eluting significantly reduced MACE (RR: 0.44; 95% CI: 0.18 to 0.98) and ID-TLR (RR: 0.47; 95 % CI: 0.23 to 0.97). There was no difference in MI (RR: 0.48; 95% CI: 0.16 to 1.46), TLR (RR: 0.46; 95% CI: 0.20 to 1.04) and ST ((RR: 0.34; 95% CI: 0.05 to 2.39). Five-year outcomes of everolimus-eluting stent compared to paclitaxel-eluting: There was no difference in ID-TLR (RR: 0.67; 95% CI: 0.45 to 1.02) and ST (RR: 0.71; 95% CI: 0.28 to 1.80).

Conclusions: In the present meta-analysis, everolimus-eluting appeared to be safe and clinically effective in patients undergoing PCI in comparison to PES in 3-year clinical outcomes; there was similar no difference in reduction of ST between EES and PES in long-term(≥ 4 years) clinical follow-ups. Everolimus-eluting is more safety than paclitaxel-eluting in long-term clinical follow-ups, whether these effects can be applied to different patient subgroups warrants further investigation.

Fig. 1

Data source flow chart diagram

Fig. 2

Risk of bias graph

Fig. 3

Funnel plot of primary outcomes included in the meta-analysis. The funnel plot of (a: 3-year MACE, b: 3-year MI, c: 3-year death, d: 3-year ST, e: 4-year MACE, f: 4-year MI, g: 5-year ST). the standard error (SE) of the ln relative risk (RR) was plotted against the relative risk for (a:3-year MACE, b: 3-year MI, c: 3-year death, d: 3-year ST, e: 4-year MACE, f: 4-year MI, g: 5-year ST) 3-year MACE. The absence of any asymmetric distribution suggested no publication bias

Fig. 4

Risk Ratio of 3-year clinical outcomes: the Risk Ratio of (a: MACE, b: MI, c: all cause of death; d: ST; e: TLR, f: TVR, g: ID-TLR) at 3-year follow-up associated with EES versus PES

Fig. 5

Risk Ratio of 4-year clinical outcomes: the Risk Ratio of a: MACE, b: MI; c: ST; d: TLR; e: ID-TLR) at 4-year follow-up associated with EES versus PES

Fig. 6

Risk Ratio of 5-year clinical outcomes: the Risk Ratio of a: ST, b: ID-TLR) at 5-year follow-up associated with EES versus PES