Zotarolimus-eluting stent versus sirolimus-eluting and paclitaxel-eluting stents for percutaneous coronary intervention: A meta-analysis of randomized trials

Summary Background The zotarolimus-eluting stent (ZES) is a new drug-eluting stent that delivers zotarolimus, a synthetic analogue of sirolimus, through a biocompatible phosphorylcholine polymer coating. ZES has shown promising results compared with bare-metal stents, but its safety and efficacy against sirolimus-eluting (SES) and paclitaxel-eluting (PES) stents is yet to be established. Aims We aimed to summarize current evidence from randomized trials comparing ZES with SES and PES. Methods We searched the Medline, Embase and CENTRAL databases for randomized studies comparing ZES with SES and PES for percutaneous coronary intervention. Relevant clinical and angiographic outcomes were extracted and combined using random and fixed-effect models for heterogeneous and homogenous outcomes, respectively. Results Seven randomized trials met the inclusion criteria: ZES group, n  = 3787; SES group, n  = 2606; PES group, n  = 1966. Compared with SES, ZES was associated with significantly higher odds of clinically driven target vessel revascularization (odds ratio [OR] 2.36, 95% confidence interval [CI] 1.78–3.14) and target lesion revascularization (OR 2.46, 95% CI 1.36–4.46). Compared with SES, ZES had higher in-stent restenosis (OR 6.13, 95% CI 3.96–9.50), late lumen loss ‘in-stent’ (mean difference [MD] 0.39 mm, 95% CI 0.34–0.44) and late lumen loss ‘in-segment’ (MD 0.18 mm, 95% CI 0.15–0.21). ZES was associated with higher in-stent late lumen loss than PES (MD 0.18 mm, 95% CI 0.07–0.28). There were no differences in mortality, reinfarction or stent thrombosis with ZES compared with SES and PES. Conclusion ZES is not superior to PES and is inferior to SES in terms of angiographic outcomes and clinically driven revascularization.