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lüll The efficacy of sirolimus- and paclitaxel-eluting stents: a meta-analysis of randomized controlled trials Kittleson MM; Needham DM; Kim SJ; Ravindran BK; Solomon SS; Guallar ECan J Cardiol 2005[May]; 21 (7): 581-7BACKGROUND: 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 revascularization, 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 PNPOL, respectively, with significant differences between SES and PPOL and between PPOL and PNPOL (P < 0.01 for both comparisons). However, sensitivity analysis using the OR of target lesion revascularization 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 infarction 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 revascularization 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.|*Drug Delivery Systems[MESH]|*Stents[MESH]|Age Factors[MESH]|Aged[MESH]|Angioplasty, Balloon, Coronary/*instrumentation/methods[MESH]|Coronary Angiography[MESH]|Coronary Restenosis/diagnostic imaging/epidemiology[MESH]|Dose-Response Relationship, Drug[MESH]|Female[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Myocardial Infarction/diagnostic imaging/mortality/*therapy[MESH]|Paclitaxel/*administration & dosage[MESH]|Prognosis[MESH]|Randomized Controlled Trials as Topic[MESH]|Severity of Illness Index[MESH]|Sex Factors[MESH]|Sirolimus/*administration & dosage[MESH]|Survival Analysis[MESH]|Treatment Outcome[MESH] |