Efficacy and safety of zotarolimus-eluting stents compared with sirolimus-eluting stents in patients undergoing percutaneous coronary interventions - A meta-analysis of randomized controlled trials

Background: Whether ZES can further improve angiographic and clinical outcomes compared to SES still remains uncertain. Objectives: The aim of this study was to assess the efficacy and safety of zotarolimus-eluting stents (ZES) compared with sirolimus-eluting stents (SES) in patients undergoing percutaneous coronary interventions (PCI). Methods: Major electronic information sources were explored for randomized controlled trials comparing ZES with SES among patients undergoing PCI during at least 9 months follow-up. The primary efficacy outcomes were target lesion revascularization (TLR), target vessel revascularization (TVR), and major adverse cardiac events (MACE); safety outcomes were stent thrombosis (ST), myocardial infarction (MI), and cardiac death. Results: Seven comparative studies were identified (a total of 5983 patients). When compared with ZES at 12-month follow-up, SES significantly reduced risk of MACE (relative risk [RR]: 0.74, 95% confidence interval [CI]: 0.61 to 0.89, p=0.002), and TLR (RR: 0.39; 95% CI: 0.29 to 0.52; p<0.00001), without significant differences in terms of TVR (RR: 0.68, 95% CI: 0.38 to 1.20; p=0.18), ST (RR: 0.71; 95% CI: 0.39 to 1.31; p=0.28), cardiac death (RR: 0.83; 95% CI: 0.49-1.42, p=0.50) or MI (RR: 1.08; 95% CI: 0.80 to 1.45; p=0.62). Conclusions: At 12-month follow-up, SES are superior to ZES in reducing the incidences of TLR and MACE in patients undergoing PCI, without significant differences in terms of TVR, ST, cardiac death, and MI. (C) 2012 Elsevier Ireland Ltd. All rights reserved.