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Long-term risk of late and very late stent thrombosis in patients treated with everolimus against paclitaxel-eluting stents: an updated meta-analysis

Li, Penga; Liu, Jun-Pengb

doi: 10.1097/MCA.0000000000000109
Original Research

Objectives Everolimus-eluting stent (EES) reduces the risk of late and very late stent thrombosis (ST) in a number of randomized controlled trials (RCTs). However, the benefits have been variable.

Materials and methods We evaluated the effect of EES and paclitaxel-eluting stent (PES) on the risk of late and very late ST in patients with coronary artery disease.

Results We identified RCTs by a systematic search of MEDLINE, EMBASE, and Cochrane Database. Seven RCTs (8162 patients) were included. Overall, EES therapy lowered the risk of very late ST significantly [relative risk (RR), 0.40; 95% confidence interval (CI), 0.20–0.80; I 2=0.0%; P=0.009] compared with PES. Meanwhile, EES was associated with a significantly lower incidence of major adverse cardiac events (RR, 0.76; 95% CI, 0.67–0.86; I 2=34.2%; P=0.00) driven by a markedly lower rate of myocardial infarction and target-vessel revascularization in the EES group. However, there was no significant difference in the risk of late ST (RR, 0.45; 95% CI, 0.15–1.39; I 2=30.7%; P=0.166) between the two groups. A subgroup analysis showed that EES might not decrease the risk of very late ST significantly in patients older than 63.5 years or in patients with diabetes, those presenting with acute coronary syndrome, or those with a longer follow-up.

Conclusion Compared with PES, EES treatment decreased risk of very late ST significantly. However, the risk of late ST was similar between the two groups. More studies are needed to confirm the subgroup findings.

aDepartment of ICU, Peking University Shougang Hospital

bDepartment of Cardiology, Beijing Hospital, Beijing, China

Correspondence to Jun-Peng Liu, MD, Department of Cardiology, Beijing Hospital, No. 1 Dahua Road, Dongcheng District, Beijing 100730, China Tel: +86 010 13810323577; fax: +86 651 32969; e-mail:

Received January 8, 2014

Received in revised form February 6, 2014

Accepted February 17, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins