Background: The meta-analysis was aimed to compare the long time (> 2 year) clinical outcomes of limus-based stents (LBS) and paclitaxel-eluting stents (PES). LBS and PES are two kinds of most common coronary artery stents in clinics.

Methods: Electronic data bases of PubMed, Cochrane, and EMBASE were searched. We included randomized controlled clinical trials (RCT) comparing LBS and PES with long time clinical outcomes. Methodological quality of eligible trials was assessed using “risk of bias” tool. The efficacy endpoints included target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis (ST), and the safety endpoints included all cause death, cardiac death, and myocardial infarction (MI). Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated for each endpoint.

Results: A total of 23 RCTs and 19,319 participants were included and analyzed in this meta-analysis. All trials were of an acceptable quality. At 2 years, LBS showed reduced risk of revascularization and ST (TLR: OR = 0.59, 95% CI 0.44–0.78; TVR: OR = 0.63, 95% CI 0.55–0.71; ST: OR = 0.55, 95% CI 0.41–0.73) and a lower rate of MI (OR = 0.67, 95% CI 0.57–0.79). Subgroup analysis showed that both everolimus-eluting stents and sirolimus-eluting stents had better clinical outcomes compared with PES. The comparisons of 3, 4 and 5 year follow-up results revealed that the clinical outcomes of PES were non-inferior to those of LBS but LBS was associated with reduced risk of MI and ST at 3 years.

Conclusions: LBS is associated with better clinical outcomes at 2 years. Both LBS and PES showed similar efficacy and safety at long time period.