Outcomes with first-versus second-generation drug-eluting stents in coronary chronic total occlusions (CTOs): A systematic review and meta-analysis

Viswanatha Lanka, Vishal G. Patel, Bilal Saeed, Anna Kotsia, George Christopoulos, Bavana V. Rangan, Atif Mohammad, Michael Luna, Santiago Garcia, Shuaib M. Abdullah, Jerrold Grodin, Jeffrey L. Hastings, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalReview articlepeer-review

22 Scopus citations


OBJECTIVE: The objective of the present study was to perform a systematic review and meta-analysis of studies reporting outcomes after first- and second-generation drug-eluting stent (DES) implantation in chronic total occlusions (CTOs). BACKGROUND: The effect of second- vs first-generation DESs on the outcomes after CTO percutaneous coronary intervention (PCI) has received limited study. METHODS: As of May 2013, thirty-one published studies reported outcomes after DES implantation in CTOs: thirteen uncontrolled studies (3161 patients), three randomized (220 patients) and ten non-randomized (2150 patients) comparative studies with bare-metal stents (BMSs), and two non-randomized (685 patients) and three randomized (489 patients) comparative studies between first- and second-generation DESs. Data from the five studies comparing first with second-generation DESs were pooled using random-effects meta-analysis models. RESULTS: The median and mean duration of follow-up were 12 and 14.4 months, respectively. Compared to first-generation DESs, second-generation DESs were associated with lower incidence of death (odds ratio [OR], 0.37; 95% confidence intervals [CI], 0.15-0.91), target vessel revascularization (OR, 0.59; 95% CI, 0.40-0.87), binary angiographic restenosis (OR, 0.68; 95% CI, 0.46-1.01) and reocclusion (OR, 0.35; 95% CI, 0.17-0.71), but similar incidence of myocardial infarction (OR, 0.45; 95% CI, 0.10-1.95) and stent thrombosis (OR, 0.34; 95% CI, 0.07-1.59). CONCLUSIONS: Compared to first-generation DESs, second-generation DESs are associated with improved angiographic and clinical outcomes in CTO PCI and are the preferred stents for these challenging lesions.

Original languageEnglish (US)
Pages (from-to)304-310
Number of pages7
JournalJournal of Invasive Cardiology
Issue number7
StatePublished - Jul 2014


  • bare-metal stent
  • everolimus-eluting stent
  • paclitaxel-eluting stent
  • percutaneous coronary intervention
  • restenosis
  • sirolimus-eluting stent
  • zotarolimus-eluting stent


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