Adjusted indirect comparison of intracoronary drug-eluting stents: evidence from a metaanalysis of randomized bare-metal-stent-controlled trials
Adjusted indirect comparison of intracoronary drug-eluting stents: evidence from a metaanalysis of randomized bare-metal-stent-controlled trials
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DOI：
10.1016/j.ijcard.2004.11.001
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发表时间：
2005-04-08
影响因子：
3.5
通讯作者：
Colombo, A
中科院分区：
文献类型：
--
作者：
Biondi-Zoccai, GL;Agostoni, P;Colombo, A
目的：最近对药物洗脱支架（DES）进行了研究，获得了许多器械的有利数据，但缺乏比较数据。因此，我们进行了调整后的间接比较荟萃分析DES.Methods：随机试验比较DES与裸金属支架（BMS）进行了系统的搜索，并计算随机效应比值比（OR）的靶病变血运重建（TLR）和二元支架内再狭窄率（BRR）在6-12个月。然后，我们产生的相互作用或比较不同的DES.Results：我们汇集了17项研究（分配3048例患者的BMS和3392 9种不同的DES）的数据。西罗莫司洗脱Cypher（N=1007）与聚合紫杉醇洗脱Taxus（N=959）的间接头对头比较显示TLR无显著差异[OR=0.8（0.5-1.4），p=0.45]，但BRR显著降低，有利于Cypher [OR=0.3（0.1-0.6），p < 0.001]。依维莫司洗脱支架似乎不劣于Cypher或Taxus（TLR和BRR均p > 0.50）。放线菌素，霉酚酸酯，和apolymeric紫杉醇洗脱支架（PES）的TLR或BRR.Conclusion：尽管其固有的局限性，目前的荟萃分析证实了Cypher和紫杉醇的有效性，支持依维莫司洗脱支架的前景广阔的作用，并表明大多数其他设备的显着劣效性。这些事后调查结果虽然有趣，但仍有待进一步证实。(c)2004爱思唯尔爱尔兰有限公司保留所有权利。
Aims: Drug-eluting stents (DES) have been recently investigated, with favorable data for many devices, but comparative data are lacking. We thus performed an adjusted indirect comparison metaanalysis of DES.Methods: Randomized trials comparing DES vs. bare-metal stents (BMS) were systematically searched, and random effect odds ratios (OR) were computed for target lesion revascularization (TLR) and binary in-stent restenosis rate (BRR) at 6-12 months. We then generated interaction OR for the comparison of different DES.Results: We pooled data from 17 studies (allocating 3048 patients to BMS and 3392 to nine different DES). Indirect head-to-head comparison of sirolimus-eluting Cypher (N=1007) vs. polymeric paclitaxel-eluting Taxus (N=959) showed nonsignificant differences in TLR [OR=0.8 (0.5-1.4), p=0.45] but significant reductions in BRR favoring Cypher [OR=0.3 (0.1-0.6), p < 0.001]. Everolimus-eluting stents appeared noninferior to Cypher or Taxus (p > 0.50 for both TLR and BRR). Actinomycin-, mycophenolate-, and apolymeric paclitaxel-eluting stents (PES) all proved significantly worse than Cypher or Taxus for TLR or BRR.Conclusion: Notwithstanding its inherent limitations, the present metaanalysis confirms the effectiveness of both Cypher and Taxus, supports the promising role of everolimus-eluting stents, and suggests the significant inferiority of most other devices. These post hoc findings, albeit intriguing, await prospective confirmation. (c) 2004 Elsevier Ireland Ltd. All rights reserved.