Drug-Eluting Stent In Coronary Artery Disease:a Meta-analysis

Objectives: To evaluate the efficiency and safety of drug-eluting stent in treating patients with coronary artery disease compare with bare metal stent. Method: Medline, EMBASE, CBMdisc and other database of clinical trial were searched for Chinese and English language meta analysis and randomized controlled trials. Conference abstract, personal reference lists, reference lists of retrieved studies and some websites were also searched. Statistical analysis was done using the software of RevMan 4.2. Main results: Meta-analyses were performed on the results of 25 randomized controlled trials with 5 different drug-eluting stents. 7 trials evaluated efficiency and safety of sirolimus-eluting stent, the results of meta analysis indicated that SES decrease rates of in stent restenosis compare with bare metal stent(OR=0.20, 95%CI: 0.15, 0.29), and therefore the target lesion revascularization(OR=0.20, 95%CI: 0.15, 0.29) and adverse cardiac event rate(OR=0.29, 95%CI: 0.22, 0.38), no "catch up" was found. 9 trials compared paclitaxel-eluting stent with bare metal stent, similar results were found that in decreased stent restenosis rate, target lesion revascularization and adverse cardiac event rates in patients received paclitaxel-eluting stent compare with bare metal stent. 3 trials compared CYPHER? and TAXUS? stent head to head, combined analysis directed the superiority of CYPHER? to TAXUS?. But available data do not allow for conclusions to be made with regard to the effect of drug-eluting stent on mortality or in the case of MI or stent thrombosis. Everolimus-eluting stent has the same performanceof these two drug-eluting stent, but limited by the sample size, no further conclusion can be made. Actinomycin D eluting stent and 7-hexanoyltaxol-eluting stent increase restenosis rate and stent thrombosis rate respectively. Poor performance limited further clinical trial of these two stents.Reviewers' conclusions: Sirolimus-eluting stent and polymetric paclitaxel -eluting stent are efficient and safety in patient with coronary artery atherosclerosis. Sirolimus eluting stent CYPHER? seems better than paclitaxel eluting stent TAXUS?. This conclusion is limited to narrow patient include criteria, length of follow-up. To have a global evaluation of efficient and safety of drug-eluting stent, more large sample RCT in "real world" patient need to be performed, and systematic review of non-RCTs which evaluate performance of other drug-eluting stents is necessary.