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Two zotarolimus-eluting stent generations: a meta-analysis of 12 randomised trials versus other limus-eluting stents and an adjusted indirect comparison
  1. Salvatore Cassese,
  2. Gjin Ndrepepa,
  3. Lamin A King,
  4. Tomohisa Tada,
  5. Massimiliano Fusaro,
  6. Adnan Kastrati
  1. Deutsches Herzzentrum, Technische Universität, Munich, Germany
  1. Correspondence to Dr Professor Adnan Kastrati, Deutsches Herzzentrum, Technische Universität, Lazaretstr. 36, Munich 80636, Germany; kastrati{at}


Objective To evaluate efficacy and safety of two zotarolimus-eluting stent generations versus other limus-eluting stents (LES), and to compare Resolute zotarolimus-eluting stents (R-ZES) with Endeavor zotarolimus-eluting stents (E-ZES).

Background The performance of zotarolimus-eluting stents versus other LES, and the possible improvements of R-ZES versus E-ZES still remain to be defined.

Methods We undertook a meta-analysis of trials in which patients were randomly assigned to percutaneous coronary interventions (PCI) with R-ZES versus LES, or with E-ZES versus LES, as well as an indirect comparison of R-ZES versus E-ZES, with LES as common comparator. The primary efficacy endpoint was ischaemia-driven target vessel revascularisation (ID-TVR); the primary safety endpoints were myocardial infarction (MI), cardiac death and cumulative definite/probable stent thrombosis (ST).

Results Overall, 13'709 patients were assigned to PCI with R-ZES versus LES (n=7185) or with E-ZES versus LES (n=6524). The risk of ID-TVR (OR (95% CI)=1.06 (0.90 to 1.25), p=0.47), MI (1.00 (0.81 to 1.25), p=0.97), cardiac death (0.99 (0.69 to 1.42), p=0.96) and ST (1.18 (0.68 to 2.03), p=0.56) did not differ between R-ZES and LES. Patients receiving E-ZES were more likely to undergo ID-TVR as compared with those receiving LES (1.95 (1.40 to 2.73), p<0.0001). The risk of MI (0.91 (0.54 to 1.54), p=0.73), cardiac death (1.02 (0.54 to 1.91), p=0.96) and ST (1.10 (0.50 to 2.44), p=0.81) was similar between E-ZES and LES. At indirect comparison, PCI with R-ZES versus E-ZES reduced the risk of ID-TVR (0.54 (0.37 to 0.78), p=0.001), without increasing MI (1.09 (0.62 to 1.93), p=0.74), cardiac death (0.97 (0.46 to 2.00), p=0.93) and ST (1.07 (0.40 to 2.80), p=0.88).

Conclusions The antirestenotic efficacy of Resolute zotarolimus-eluting stents is superior to Endeavor zotarolimus-eluting stents and similar to other limus-eluting stents. Endeavor zotarolimus-eluting stents increase the risk of reinterventions as compared with other limus-eluting stents. First and second-generation zotarolimus-eluting stents have similar thrombogenicity compared with other limus-eluting stents.

  • Zotarolimus-eluting stent
  • drug-eluting stents
  • meta-analysis
  • adjusted indirect comparison
  • coronary artery disease
  • atherosclerosis
  • interventional cardiology
  • coronary intervention (PCI)
  • non-coronary intervention
  • myocardial ischaemia and infarction (IHD)
  • coronary physiology
  • allied specialities
  • haematology
  • acute coronary syndrome
  • restenosis
  • stent interventions
  • PTCA
  • acute myocardial infarction

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  • Dr AK holds a patent related to polymer-free sirolimus and probucol coating. Dr. AK has received honoraria from Abbott, Cordis and Medtronic.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by Meta-analysis of RCTs.

  • Provenance and peer review Not commissioned; externally peer reviewed.