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In response to ongoing controversy about the safety of drug eluting stents compared with bare metal stents, researchers analysed data from 38 randomised trials including more than 18000 people with coronary ischaemia. Bare metal stents, paclitaxel eluting stents, and sirolimus eluting stents were all associated with similar overall mortality and similar cardiac mortality over four years. But patients given a sirolimus eluting stent were significantly less likely to have a heart attack than patients given the other two types of stent. Both drug eluting stents reduced the need for further revascularisation compared with bare metal stents. The difference was greatest for stents eluting sirolimus (hazard ratio 0.7, 95% credibility interval 0.56 to 0.84).
All three stent types were associated with similar rates of stent thrombosis overall. Patients with paclitaxel eluting stents had around twice as many late thromboses (after more than 30 days) than patients with either bare metal or sirolimus eluting stents.
These findings are the most precise available so far, and they suggest that sirolimus eluting stents have a better risk-benefit ratio than the only other drug eluting stent on the market, say the authors. This meta-analysis was designed, analysed, interpreted, and published independently of any sponsors.