Document Detail


Mortality in randomized controlled trials comparing drug-eluting vs. bare metal stents in coronary artery disease: a meta-analysis.
MedLine Citation:
PMID:  17020889     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: To evaluate the effect of drug-eluting vs. bare metal stents for the treatment of coronary artery disease on overall, cardiac, and non-cardiac mortalities. METHODS AND RESULTS: We conducted a systematic literature search to identify all randomized controlled trials comparing sirolimus or paclitaxel-eluting stents with bare metal stents and reporting mortality data after at least 1 year of follow-up. Trial data were reviewed and extracted independently by two investigators in an unblinded standardized manner. Seventeen trials including a total of 8221 patients were analysed. Peto's odds ratios (ORs) for total mortality after 1 (n=8221), 2 (n=4631), 3 (n=4105), and 4 (n=1293) years of follow-up were 0.94 [95% confidence interval (CI) 0.66-1.34], 1.11 (95% CI 0.76-1.61), 1.25 (95% CI 0.91-1.73), and 1.46 (95% CI 0.92-2.31), respectively. Corresponding ORs for non-cardiac mortality were 1.07 (95% CI 0.64-1.80), 1.72 (95% CI 1.01-2.94), 1.45 (95% CI 0.93-2.25), and 1.65 (95% CI 0.89-3.10). There was no difference in OR for cardiac mortality among all trials. In sensitivity analyses, sirolimus- but not paclitaxel-eluting stents were associated with an increase in non-cardiac mortality at 2 and 3 years of follow-up. CONCLUSION: Drug-eluting stents for the treatment of coronary artery disease do not reduce total mortality when compared with bare metal stents. Preliminary evidence suggests that sirolimus- but not paclitaxel-eluting stents may lead to increased non-cardiac mortality. Long-term follow-up and assessment of cause-specific deaths in patients receiving drug-eluting stents is mandatory to determine the long-term safety of these devices.
Authors:
Alain Joel Nordmann; Matthias Briel; Heiner Claudins Bucher
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review     Date:  2006-10-04
Journal Detail:
Title:  European heart journal     Volume:  27     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-11-23     Completed Date:  2007-04-16     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  2784-814     Citation Subset:  IM    
Affiliation:
Basel Institute for Clinical Epidemiology, University Hospital Basel, Hebelstrasse 10, 4031 Basel, Switzerland. nordmanna@uhbs.ch
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Artery Disease / mortality,  therapy*
Drug Implants
Follow-Up Studies
Graft Occlusion, Vascular / etiology
Humans
Immunosuppressive Agents / administration & dosage*
Middle Aged
Paclitaxel / administration & dosage*
Randomized Controlled Trials as Topic
Sensitivity and Specificity
Sirolimus / administration & dosage*
Stents*
Tubulin Modulators / administration & dosage*
Chemical
Reg. No./Substance:
0/Drug Implants; 0/Immunosuppressive Agents; 0/Tubulin Modulators; 33069-62-4/Paclitaxel; 53123-88-9/Sirolimus
Comments/Corrections
Comment In:
Eur Heart J. 2006 Dec;27(23):2737-9   [PMID:  17107977 ]
Eur Heart J. 2006 Dec;27(24):3075-6; author reply 3076   [PMID:  17127710 ]
ACP J Club. 2007 May-Jun;146(3):66   [PMID:  17474675 ]

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