The impact of everolimus versus other rapamycin derivative-eluting stents on clinical outcomes in patients with coronary artery disease: A meta-analysis of 16 randomized trials

Background: Everolimus-eluting stent (EES) are considered to have better clinical outcomes than other rapamycin derivative-eluting stents; however, the individual trials may not have sufficient power to prove it. This meta-analysis aimed to compare clinical outcomes of EES against other rapamycin derivative-eluting stents. Methods: We searched Medline, the Cochrane Library, and other internet sources, without language or date restrictions for articles comparing clinical outcomes between EES and other rapamycin derivative-eluting stents. Safety endpoints were stent thrombosis (ST), mortality, cardiac death, and myocardial infarction (MI). Efficacy endpoints were major adverse cardiac events (MACE), target lesion revascularization (TLR), and target vessel revascularization (TVR). Results: We identified 16 randomized controlled trials with 23,481 patients and a weighted mean follow-up of 18 months. Compared with other rapamycin derivative-eluting stents, EES were associated with a significant reduction in definite ST [relative risk (RR): 0.45; 95% confidence interval (CI): 0.30-0.69; p < 0.001] and TLR (RR: 0.87; 95% CI: 0.77-0.99; p = 0.03). EES also showed a non-significant trend toward reduction in definite/probable ST (RR: 0.75; 95% CI: 0.56-1.01; p = 0.06). However, both groups had similar rates of mortality (RR: 0.95; 95% CI: 0.82-1.09; p = 0.45), MI (RR: 0.95; 95% CI: 0.82-1.10; p = 0.43), and MACE (RR: 0.94; 95% CI: 0.87-1.02; p = 0.35). The stratified analysis of the included trials showed that EES was associated with significantly lower rate of definite ST compared with either zotarolimus-eluting stent (p = 0.012) or sirolimus-eluting stent (p = 0.006), but not biolimus-eluting stent (p = 0.16). In longer follow-up (>1 year) stratification, EES was associated with a significant reduction in risk of definite ST (p < 0.001). Conclusions: EES is associated with a significant reduction in definite ST and TLR for treating patients with coronary artery disease, compared with a pooled group of other rapamycin derivative-eluting stents. Biolimus-eluting stent had similar safety and efficacy for treating patients with coronary artery disease, compared with the EES.