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Sirolimus-Eluting Stents vs Paclitaxel-Eluting Stents in Patients With Coronary Artery Disease:  Meta-analysis of Randomized Trials FREE

Adnan Kastrati, MD; Alban Dibra, MD; Sonja Eberle, Dipl Stat; Julinda Mehilli, MD; José Suárez de Lezo, MD; Jean-Jacque Goy, MD; Kurt Ulm, PhD; Albert Schömig, MD
[+] Author Affiliations

Author Affiliations: Deutsches Herzzentrum (Drs Kastrati, Dibra, Mehilli, and Schömig) and Institut für Medizinische Statistik und Epidemiologie (Drs Eberle and Ulm), Technische Universität, Munich, Germany; Reina Sofia Hospital, Cordoba, Spain (Dr Suárez de Lezo); and Service of Cardiology, Clinique Cecil, Lausanne, Switzerland (Dr Goy).

More Author Information
JAMA. 2005;294(7):819-825. doi:10.1001/jama.294.7.819.
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Published online

Context Placement of sirolimus-eluting stents or paclitaxel-eluting stents has emerged as the predominant percutaneous treatment strategy in patients with coronary artery disease (CAD). Whether there are any differences in efficacy and safety between these 2 drug-eluting stents is unclear.

Objective To compare outcomes of sirolimus-eluting and paclitaxel-eluting coronary stents on the basis of data generated by randomized head-to-head clinical trials.

Data Sources PubMed and the Cochrane Central Register of Controlled Trials, conference proceedings from major cardiology meetings, and Internet-based sources of information on clinical trials in cardiology from January 2003 to April 2005.

Study Selection Randomized trials comparing the sirolimus-eluting stent with the paclitaxel-eluting stent in patients with CAD reporting the outcomes of interest (target lesion revascularization, angiographic restenosis, stent thrombosis, myocardial infarction [MI], death, and the composite of death or MI) during a follow-up of at least 6 months.

Data Extraction Two reviewers independently identified studies and abstracted data on sample size, baseline characteristics, and outcomes of interest.

Data Synthesis Six trials, including 3669 patients, met the selection criteria. No significant heterogeneity was found across trials. Target lesion revascularization, the primary outcome of interest, was less frequently performed in patients who were treated with the sirolimus-eluting stent (5.1%) vs the paclitaxel-eluting stent (7.8%) (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.49-0.84; P = .001). Similarly, angiographic restenosis was less frequently observed among patients assigned to the sirolimus-eluting stent (9.3%) vs the paclitaxel-eluting stent (13.1%) (OR, 0.68; 95% CI, 0.55-0.86; P = .001). Event rates for sirolimus-eluting vs paclitaxel-eluting stents were 0.9% and 1.1%, respectively, for stent thrombosis (P = .62); 1.4% and 1.6%, respectively, for death (P = .56); and 4.9% and 5.8%, respectively, for the composite of death or MI (P = .23).

Conclusions Patients receiving sirolimus-eluting stents had a significantly lower risk of restenosis and target vessel revascularization compared with those receiving paclitaxel-eluting stents. Rates of death, death or MI, and stent thrombosis were similar.

Figures in this Article

Although stenting has improved outcomes in patients undergoing percutaneous coronary interventions, bare-metal stents are associated with an increased risk of restenosis, in particular in high-risk subsets.1,2 Drug-eluting stents, which have the capacity to reduce neointimal hyperplasia via local delivery of antiproliferative agents, have recently emerged as an effective solution to the problem of restenosis.3,4 Numerous trials have demonstrated that the sirolimus-eluting and the paclitaxel-eluting stents, the most studied drug-eluting stents and the only stents so far approved for use by the US Food and Drug Administration, are much more effective than bare-metal stents in preventing restenosis.510 The superior efficacy of drug-eluting stents compared with bare-metal stents has also been reported in systematic reviews.11

In contrast, evidence on the relative performance of the sirolimus-eluting stent and paclitaxel-eluting stent has just begun to accrue. Recently, several randomized studies addressed the issue of the potential differences in performance between the 2 drug-eluting stents, which account for more than 85% of the coronary stents currently used in the United States.12 Meta-analysis is a valuable analytical tool for summarizing results from different, but comparable, individual studies.13 Herein, we report the results of a meta-analysis of recent randomized trials comparing the sirolimus-eluting stent with the paclitaxel-eluting stent in patients with coronary artery disease (CAD).

Objective

The objective of our meta-analysis was to assess the efficacy and safety of the sirolimus-eluting stent compared with the paclitaxel-eluting stent in patients with CAD.

Criteria for Study Selection

To be selected for this meta-analysis, studies had to include patients with symptoms or objective signs of myocardial ischemia due to CAD who were assigned to treatment with a sirolimus-eluting stent or a paclitaxel-eluting stent in a randomized fashion. All studies had to report the outcomes of interest during a follow-up period of at least 6 months after the index procedure. No restriction criteria were imposed with regard to the form of study publication.

Outcomes and Definitions

The primary outcome of interest was target lesion revascularization, which was defined as any revascularization procedure, percutaneous or surgical, involving the target lesion. Other clinical outcomes of interest were stent thrombosis, myocardial infarction (MI), death, and the composite of death or MI. The angiographic outcome of interest was binary restenosis, which was defined as diameter stenosis of at least 50% at follow-up, measured by quantitative angiography in the area, including the stented area as well as the 5-mm margins proximal and distal to the stent.

Data Sources

We searched PubMed and the Cochrane Central Register of Controlled Trials for randomized trials comparing the sirolimus-eluting stent with the paclitaxel-eluting stent in patients with CAD. In addition, we searched conference proceedings from the American College of Cardiology, American Heart Association, and European Society of Cardiology. Searches were restricted to the period from January 2003 to April 2005. Relevant reviews and editorials from major medical journals published within the last year were identified and assessed for possible information on trials of interest. Internet-based sources of information on the results of clinical trials in cardiology (http://www.theheart.org and http://www.tctmd.com) were also searched.

Data Collection and Assessment of Quality

Studies were selected and data were extracted independently by 2 reviewers (A.D. and J.M.). Disagreements were resolved by consensus. We recorded the following clinical and angiographic characteristics, in addition to the number of participating patients: age, sex, diabetes mellitus, number of treated lesions, mean reference diameter of the vessel where the lesion was located, and mean lesion length. Duration of clinical follow-up and time point of follow-up angiography as well as clinical follow-up rates were also recorded. Raw data obtained from source information of the individual studies were used for all analyses.

We referred to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions 4.2.4 for our meta-analysis.14 We evaluated studies for the adequacy of allocation concealment, performance of the analysis according to the intention-to-treat principle, and blind assessment of the outcomes of interest. We used the criteria recommended by Altman and Schulz15 and Jüni et al16 to decide whether treatment allocation was adequately concealed. We did not use a summary score to identify trials of low or high quality, or perform weighting by quality scores as this practice has been discouraged by some.1618 Although acknowledging that studies included in our meta-analysis cannot be absolutely equal to each other regarding their methodological quality, the gathered information allowed us to consider these trials of adequate quality regarding concealment of treatment allocation, performance of analyses according to the intention-to-treat principle, and evaluation of outcomes of interest by blinded assessors.

Statistical Analyses

All analyses were performed based on the intention-to-treat principle. There was no need for data imputation. Odds ratios (ORs) with 95% confidence intervals (CIs) were computed as summary statistics. The pooled OR was calculated with the Mantel-Haenszel method for fixed effects19 and the DerSimonian and Laird method for random effects.20 To assess heterogeneity across trials, we used the Cochran Q test based on the pooled OR by Mantel-Haenszel. Heterogeneity was also assessed by means of I2 statistic as proposed by Higgins et al.21 Results were considered statistically significant at P<.05. A funnel plot as well as the adjusted rank correlation test, according to the method of Begg and Mazumdar,22 were used to assess publication bias with respect to the primary outcome of interest, target lesion revascularization. Statistical analyses were performed with Stata software version 8.2 (Stata Corp, College Station, Tex).

Our search identified 6 randomized trials, which compared the sirolimus-eluting stent with the paclitaxel-eluting stent in 3669 patients with CAD.2328 (After this paper was accepted for publication, 2 of the trials included in the meta-analysis as abstracts from conference proceedings25,27 were published.29,30) Angiographic restenosis was the primary end point in 3 trials.23,24,26 Late lumen loss in follow-up angiography was the primary end point in 1 trial.25 The combined incidence of death, MI, and target lesion revascularization was the primary end point in the remaining 2 trials.27,28 Target lesion revascularization was a secondary end point in all of the trials.

The diagnosis of stent thrombosis was based on the presence of an acute coronary syndrome plus angiographic evidence of stent occlusion in 4 studies.2325,27 In 2 trials, this definition was expanded to include patients with unexplained sudden death28 or patients who had a Q-wave MI in the territory of the stented vessel.26 The diagnosis of MI was based on the appearance of new Q waves in the electrocardiogram or elevation of creatine kinase and its creatine kinase-MB isoenzyme levels 2 to 3 times the upper limit of normal.

A loading dose of 300 to 600 mg of clopidogrel was administered to all patients either before or at the end of the procedure in all but 1 trial.2428 In 1 trial, 500 mg of ticlopidine was administered 1 day before the procedure.23 Maintenance therapy with clopidogrel consisted of a daily dose of 75 mg. In 5 of 6 trials, the duration of clopidogrel therapy was similar (6 to 12 months) for patients of both drug-eluting stent groups.2325,27 In only 1 of the trials,26 the duration of clopidogrel therapy was different in the 2 groups; it was shorter in the group of sirolimus-eluting stent (at least 2 months) than in the group of paclitaxel-eluting stent (at least 6 months). In all studies, patients were administered aspirin indefinitely.

All trials reported the clinical outcomes of interest from a 6-month up to a 13-month follow-up period. One trial was interrupted prematurely because study investigators observed no significant difference between the 2 stents in the first 202 patients.28 Overall clinical follow-up rate was 98.2% among patients treated with the sirolimus-eluting stent and 97.8% among those treated with the paclitaxel-eluting stent. With the exception of 1 trial that did not perform routine follow-up angiography,28 the other trials reported the incidence of angiographic restenosis after a follow-up period of 6 to 8 months. Routine follow-up angiography was part of the study protocol in 3 studies.2426 In the other 2 studies,23,27 follow-up angiography was performed only in patients participating in the angiographic substudies. Angiographic restenosis rates were reported for 3229 treated lesions.

Patients included in our meta-analysis were representative of the whole clinical and angiographic spectra of CAD. No restriction criteria were applied in the SIRTAX,27 CORPAL,23 and TAXI28 trials. The ISAR-DIABETES trial25 included only patients with diabetes mellitus while the ISAR-DESIRE trial24 included only patients with in-stent restenosis. In the REALITY trial,26 patients with in-stent restenosis, ostial lesions, or totally occluded vessels were excluded.

Baseline characteristics and length of clinical follow-up are shown in Table 1. There were no significant differences between patients treated with the sirolimus-eluting stent and the paclitaxel-eluting stent regarding main entry clinical characteristics. Overall proportion of patients with diabetes mellitus was 31.6%; proportion of men was 75.5%. Similarly, patients assigned to the 2 drug-eluting stent types did not differ with respect to the main angiographic characteristics of the lesions (Table 2).

Table Graphic Jump LocationTable 1. Baseline Clinical Characteristics and Duration of Clinical Follow-up
Table Graphic Jump LocationTable 2. Baseline Angiographic Characteristics and Interval of Follow-up Angiography

Target lesion revascularization, the primary outcome of interest, was needed in 95 (5.1%) of 1845 patients assigned to the sirolimus-eluting stent group and 142 (7.8%) of 1824 patients assigned to the paclitaxel-eluting stent group (pooled OR, 0.64; 95% CI, 0.49-0.84; P = .001) by the fixed-effect model (Figure 1). There was no significant heterogeneity between trials (P = .41). No evidence of publication bias with respect to target lesion revascularization was found using the Begg funnel plot and rank correlation test (P = .89).

Figure 1. Odds Ratios of Target Lesion Revascularization Associated With Sirolimus-Eluting Stent vs Paclitaxel-Eluting Stent
Graphic Jump Location

SES indicates sirolimus-eluting stent; PES, paclitaxel-eluting stent; CI, confidence interval. The size of the data marker is proportional to the weight of the individual studies, measured as the inverse of the variance in the study by the Mantel-Haenszel procedure.

Sirolimus-eluting stents were significantly more effective in the reduction of angiographic restenosis (Figure 2). The incidence of angiographic restenosis was 9.3% (151 of 1616 lesions) among patients treated with the sirolimus-eluting stent and 13.1% (211 of 1613 lesions) among those treated with the paclitaxel-eluting stent. The pooled OR in favor of the sirolimus-eluting stent was 0.68 (95% CI, 0.55-0.86; P = .001) by the fixed effects model, with no significant study heterogeneity (P = .33).

Figure 2. Odds Ratios of Angiographic Restenosis Associated With Sirolimus-Eluting Stent vs Paclitaxel-Eluting Stent
Graphic Jump Location

SES indicates sirolimus-eluting stent; PES, paclitaxel-eluting stent; CI, confidence interval. Follow-up angiography was not performed in the TAXI trial.28 The size of the data marker is proportional to the weight of the individual studies, measured as the inverse of the variance in the study by the Mantel-Haenszel procedure.

In contrast, patients treated with sirolimus-eluting and paclitaxel-eluting stents did not differ significantly with respect to other outcomes of interest. There were 17 cases (0.9%) of stent thrombosis reported among patients who received sirolimus-eluting stents and 20 cases (1.1%) among patients who received paclitaxel-eluting stents (OR, 0.85; 95% CI, 0.46-1.59; P = .62; P = .27 for heterogeneity) (Figure 3). Few deaths occurred in the 2 stent groups (25 [1.4%] in the sirolimus-eluting stent group and 29 [1.6%] in the paclitaxel-eluting stent group; OR, 0.85; 95% CI, 0.50-1.46; P = .56; P = .48 for heterogeneity) (Figure 4). The composite of death or MI was reported in 91 patients (4.9%) in the sirolimus-eluting stent group and 106 (5.8%) in the paclitaxel-eluting stent group (OR, 0.84; 95% CI, 0.63-1.12; P = .23; P = .94 for heterogeneity) (Figure 5).

Figure 3. Odds Ratios of Stent Thrombosis Associated With Sirolimus-Eluting Stent vs Paclitaxel-Eluting Stent
Graphic Jump Location

SES indicates sirolimus-eluting stent; PES, paclitaxel-eluting stent; CI, confidence interval. The size of the data marker is proportional to the weight of the individual studies, measured as the inverse of the variance in the study by the Mantel-Haenszel procedure.

Figure 4. Odds Ratios of Death Associated With Sirolimus-Eluting Stent vs Paclitaxel-Eluting Stent
Graphic Jump Location

SES indicates sirolimus-eluting stent; PES, paclitaxel-eluting stent; CI, confidence interval. The size of the data marker is proportional to the weight of the individual studies, measured as the inverse of the variance in the study by the Mantel-Haenszel procedure.

Figure 5. Odds Ratios of the Composite of Death or Myocardial Infarction Associated With Sirolimus-Eluting Stent vs Paclitaxel-Eluting Stent
Graphic Jump Location

SES indicates sirolimus-eluting stent; PES, paclitaxel-eluting stent; CI, confidence interval. The size of the data marker is proportional to the weight of the individual studies, measured as the inverse of the variance in the study by the Mantel-Haenszel procedure.

Currently approved sirolimus and paclitaxel drug-eluting stents have become the predominant percutaneous treatment strategy for patients with CAD.12 Recently, the results of several randomized trials comparing these 2 drug-eluting stents in patients with various clinical and angiographic presentations have been made public. We performed a meta-analysis of these trials that included 3669 patients. The number of patients in each of the drug-eluting stent groups of our meta-analysis is higher than the overall number of patients who received the sirolimus-eluting stent or the paclitaxel-eluting stent in previous randomized trials that compared these drug-eluting stents with bare-metal stents. There was no significant heterogeneity among the trials. We found that the sirolimus-eluting stent was associated with a decreased risk of restenosis compared with the paclitaxel-eluting stent.

Patients who received sirolimus-eluting stents had a 36% reduction in the odds of target lesion revascularization compared with paclitaxel-eluting stents. The better clinical efficacy of the sirolimus-eluting stent was angiographically demonstrated by a 32% reduction in the odds of angiographic restenosis. Two of the studies included in our meta-analysis reported a considerable reduction in the rates of target lesion revascularization and angiographic restenosis among patients assigned to the sirolimus-eluting stent group.24,27 In the other 4 studies,23,25,26,28 a nonsignificant difference in clinical and angiographic restenosis was observed between patients who underwent sirolimus-eluting stent or paclitaxel-eluting stent implantation, with a clear trend toward a lower incidence of restenosis with the sirolimus-eluting stents in 2 of these studies.23,25

The superiority of the sirolimus-eluting stent over the paclitaxel-eluting stent in reducing the rate of restenosis found in our meta-analysis might be explained by the greater reduction of late lumen loss with the sirolimus-eluting stent uniformly demonstrated by both angiographic follow-up data2327 and intravascular ultrasound findings reported in 1 of the studies.23

A few cases of stent thrombosis were reported from the studies included in our meta-analysis. Although in the REALITY trial26 there was a trend toward a higher incidence of stent thrombosis in patients who underwent paclitaxel-stent implantation, the other studies reported comparable rates of stent thrombosis between the 2 drug-eluting stents and the pooled rates were also comparable. A recent study of consecutive patients treated with sirolimus-eluting and paclitaxel-eluting stents reported a trend toward a higher incidence of stent thrombosis with paclitaxel-eluting stents.31 The rare occurrence of stent thrombosis reduces, however, the power of our meta-analysis regarding the assessment of this complication and makes it difficult to draw any definitive conclusions on the relative safety of the sirolimus-eluting and paclitaxel-eluting stents.

We found no significant difference between the sirolimus-eluting stent and the paclitaxel-eluting stent with respect to MI, death, or their composite. Actually, none of the studies reported any difference between the 2 stent groups with respect to these outcomes of interest. The reduction in restenosis with sirolimus-eluting stent was not associated with a similar reduction in mortality or MI rate. It is likely that the low event rate and the limited length of follow-up period have not allowed the detection of potential differences in the incidences of death or MI between patients assigned to the respective drug-eluting stent groups.

Several factors may be responsible for the observed difference between the sirolimus-eluting and paclitaxel-eluting stents. Although both sirolimus and paclitaxel inhibit neointimal proliferation, there are differences in their mechanisms of action. Sirolimus is an immunosuppressive drug with anti-inflammatory properties that produces cell-cycle arrest in the G1/S phase transition and is regarded as a cytostatic agent, while paclitaxel is an antineoplastic drug that produces cell-cycle arrest in the G2/M phase transition and is regarded as a cytotoxic agent.32,33 In addition to the specific drug, another determinant of the drug-eluting stent performance is the drug delivery system, including the polymer and the stent. The different coating materials and strategies used for the sirolimus and paclitaxel stents may result in different amounts of the drug released and drug-release kinetics,34 which coupled to the distinct transmural distribution patterns in the arterial wall of sirolimus and paclitaxel,35 may influence their local pharmacological effects. The polymer coating of the sirolimus-eluting stent allows for elution of 100% of the drug, most of which occurs within 1 month.34 The polymer coating of the paclitaxel-eluting stent allows for elution of only 10% of the drug over 2 months, with 90% of paclitaxel remaining sequestered in the polymer indefinitely.34 The long-term implications of the presence of the sequestered drug are unknown.34 In addition, the sirolimus-eluting stent and the paclitaxel-eluting stent have different designs: the first has a closed-cell design while the second an open-cell design.34 It has been suggested that a closed-cell design may provide a more uniform distribution of the coated drug in the arterial wall compared with an open-cell design.32,34 Other unidentified factors may as well be responsible for the observed difference in performance between the 2 stents.

A limitation of our meta-analysis is that all individual studies included were open-label studies. This limitation cannot be circumvented in studies comparing drug-eluting stents from different manufacturers due to clear differences in stent design and delivery systems. Another limitation is that not all included studies had routine follow-up angiography as part of their protocol. However, the similarity in the calculated ORs for both clinical (target lesion revascularization) and angiographic indicators of restenosis makes it highly unlikely that there was a bias associated with incomplete angiographic follow-up. In addition, head-to-head comparisons between 2 drug-eluting stents are a new focus of clinical trials in cardiology. It is possible that new trials will be performed to compare sirolimus-eluting and paclitaxel-eluting stents. With respect to the primary end point (target lesion revascularization), a future study will need to have a sample size of 1000 patients and an OR of 2.8 in favor of the paclitaxel-eluting stent before an updated meta-analysis would fail to show a significant advantage for the sirolimus-eluting stent.

In conclusion, the results of our meta-analysis show that in patients with CAD presenting with various clinical and angiographic risk profiles, sirolimus-eluting stents are better than paclitaxel-eluting stents in reducing the risk of restenosis. Although the risk of death and MI was not significantly different between these 2 drug-eluting stents, our finding needs to be confirmed by longer follow-up studies.

Corresponding Author: Adnan Kastrati, MD, Deutsches Herzzentrum, Lazarettstrasse 36, 80636 Munich, Germany (kastrati@dhm.mhn.de).

Author Contributions: Dr Kastrati had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Kastrati, Schömig.

Acquisition of data: Kastrati, Dibra, Mehilli, Suárez de Lezo, Goy.

Analysis and interpretation of data: Kastrati, Dibra, Eberle, Mehilli, Ulm, Schömig.

Drafting of the manuscript: Kastrati, Dibra.

Critical revision of the manuscript for important intellectual content: Kastrati, Dibra, Eberle, Mehilli, Suárez de Lezo, Goy, Ulm, Schömig.

Statistical analysis: Eberle, Ulm.

Administrative, technical, or material support: Kastrati, Ulm, Schömig.

Study supervision: Kastrati, Dibra, Mehilli, Ulm, Schömig.

Financial Disclosures: None reported.

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Windecker S, Remondino A, Eberli FR.  et al.  Sirolimus-eluting and paclitaxel-eluting stents for coronary revascularization.  N Engl J Med. 2005;353:653-662
Link to Article
Iakovou I, Schmidt T, Bonizzoni E.  et al.  Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents.  JAMA. 2005;293:2126-2130
PubMed   |  Link to Article
Rogers CD. Drug-eluting stents: clinical perspectives on drug and design differences.  Rev Cardiovasc Med. 2005;6:S3-S12
PubMed
Smith EJ, Rothman MT. Antiproliferative coatings for the treatment of coronary heart disease: what are the targets and which are the tools?  J Interv Cardiol. 2003;16:475-483
PubMed   |  Link to Article
Perin EC. Choosing a drug-eluting stent: a comparison between CYPHER and TAXUS.  Rev Cardiovasc Med. 2005;6:S13-S21
PubMed
Levin AD, Vukmirovic N, Hwang CW, Edelman ER. Specific binding to intracellular proteins determines arterial transport properties for rapamycin and paclitaxel.  Proc Natl Acad Sci U S A. 2004;101:9463-9467
PubMed   |  Link to Article

Figures

Figure 1. Odds Ratios of Target Lesion Revascularization Associated With Sirolimus-Eluting Stent vs Paclitaxel-Eluting Stent
Graphic Jump Location

SES indicates sirolimus-eluting stent; PES, paclitaxel-eluting stent; CI, confidence interval. The size of the data marker is proportional to the weight of the individual studies, measured as the inverse of the variance in the study by the Mantel-Haenszel procedure.

Figure 2. Odds Ratios of Angiographic Restenosis Associated With Sirolimus-Eluting Stent vs Paclitaxel-Eluting Stent
Graphic Jump Location

SES indicates sirolimus-eluting stent; PES, paclitaxel-eluting stent; CI, confidence interval. Follow-up angiography was not performed in the TAXI trial.28 The size of the data marker is proportional to the weight of the individual studies, measured as the inverse of the variance in the study by the Mantel-Haenszel procedure.

Figure 3. Odds Ratios of Stent Thrombosis Associated With Sirolimus-Eluting Stent vs Paclitaxel-Eluting Stent
Graphic Jump Location

SES indicates sirolimus-eluting stent; PES, paclitaxel-eluting stent; CI, confidence interval. The size of the data marker is proportional to the weight of the individual studies, measured as the inverse of the variance in the study by the Mantel-Haenszel procedure.

Figure 4. Odds Ratios of Death Associated With Sirolimus-Eluting Stent vs Paclitaxel-Eluting Stent
Graphic Jump Location

SES indicates sirolimus-eluting stent; PES, paclitaxel-eluting stent; CI, confidence interval. The size of the data marker is proportional to the weight of the individual studies, measured as the inverse of the variance in the study by the Mantel-Haenszel procedure.

Figure 5. Odds Ratios of the Composite of Death or Myocardial Infarction Associated With Sirolimus-Eluting Stent vs Paclitaxel-Eluting Stent
Graphic Jump Location

SES indicates sirolimus-eluting stent; PES, paclitaxel-eluting stent; CI, confidence interval. The size of the data marker is proportional to the weight of the individual studies, measured as the inverse of the variance in the study by the Mantel-Haenszel procedure.

Tables

Table Graphic Jump LocationTable 1. Baseline Clinical Characteristics and Duration of Clinical Follow-up
Table Graphic Jump LocationTable 2. Baseline Angiographic Characteristics and Interval of Follow-up Angiography

References

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Dibra A, Kastrati A, Mehilli J.  et al.  Paclitaxel-eluting or sirolimus-eluting stents to prevent restenosis in diabetic patients.  N Engl J Med. 2005;353:663-670
Link to Article
Windecker S, Remondino A, Eberli FR.  et al.  Sirolimus-eluting and paclitaxel-eluting stents for coronary revascularization.  N Engl J Med. 2005;353:653-662
Link to Article
Iakovou I, Schmidt T, Bonizzoni E.  et al.  Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents.  JAMA. 2005;293:2126-2130
PubMed   |  Link to Article
Rogers CD. Drug-eluting stents: clinical perspectives on drug and design differences.  Rev Cardiovasc Med. 2005;6:S3-S12
PubMed
Smith EJ, Rothman MT. Antiproliferative coatings for the treatment of coronary heart disease: what are the targets and which are the tools?  J Interv Cardiol. 2003;16:475-483
PubMed   |  Link to Article
Perin EC. Choosing a drug-eluting stent: a comparison between CYPHER and TAXUS.  Rev Cardiovasc Med. 2005;6:S13-S21
PubMed
Levin AD, Vukmirovic N, Hwang CW, Edelman ER. Specific binding to intracellular proteins determines arterial transport properties for rapamycin and paclitaxel.  Proc Natl Acad Sci U S A. 2004;101:9463-9467
PubMed   |  Link to Article

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