Comparison of Everolimus-Eluting and Sirolimus-Eluting Coronary Stents

Kimura, Takeshi; Morimoto, Takeshi; Natsuaki, Masahiro; Shiomi, Hiroki; Igarashi, Keiichi; Kadota, Kazushige; Tanabe, Kengo; Morino, Yoshihiro; Tokura, Y.; Nishikawa, Hideo; Yamamoto, Yorimasa; Nakagawa, Yoshihisa; Hayashi, Yasuhiko; Iwabuchi, Masashi; Umeda, Hisashi; Kawai, Kensuke; Okada, Hisayuki; Kimura, Kazuo; Simonton, Charles A.; Kozuma, Ken

doi:10.1161/circulationaha.112.104059

Cited by 147 publications

(53 citation statements)

References 24 publications

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“…Although we could not demonstrate a difference in the angiographic outcomes in each baseline, EES exhibited better angiographic outcomes against the lesions in patients with chronic hemodialysis 16) and diabetes treated with insulin, 17) the most disadvantageous lesions for SES. 18,19) These would be attributable to the present better angiographic outcomes of EES by attenuating the impact of those factors on the present angiographic endpoints.…”

Section: Discussioncontrasting

confidence: 75%

Propensity-Score Matched Comparison of Midterm Angiographic Outcomes of Sirolimus- Versus Everolimus- and Biolimus-Eluting Stents for <i>De Novo</i> Coronary Stenosis

et al. 2017

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SummaryWe conducted propensity-score matched comparisons of midterm angiographic outcomes of sirolimus (SES) versus either everolimus-(EES) or biolimus-(BES) eluting stents after placements for coronary stenosis in a daily practice environment since previous randomized trials did not demonstrate the superiority of EES and BES over SES in terms of midterm angiographic outcomes.The present study was a non-randomized, retrospective, and lesion-based study, recruiting angiographically followed-up lesions within 550 days after successful and elective SES (n = 1793), EES (n = 1303), or BES (n = 324) placement for de novo native coronary stenosis during the period from August 2004 to January 2014 at 6 institutes. The endpoint, as an angiographic surrogate marker of clinical efficacy, was the distribution of in-stent follow-up percent diameter stenosis (%DS) which comprised the percentages of 1) follow-up %DS < 20 and 2) follow-up %DS > 50. Propensityscore matched analyses were conducted to adjust 21 baselines.In 1215 baseline adjusted lesions, the endpoints in the EES group [1) 74.1%, and 2) 4.6%] were significantly different from those in the SES group [57.9%; P < 0.001, 7.2%; P = 0.006, respectively). In 307 baseline adjusted lesions, the endpoints in the BES group [1) 80.5%, 2) 2.0%] were significantly different from those in the SES group [59.3%; P < 0.001, 2) 8.1%; P = 0.001, respectively].The present study is the first to confirm the superiority of midterm angiographic outcomes after the placement of EES and BES over SES for de novo coronary stenosis in a clinical setting. (Int Heart J 2017; 58: 320-327) Key words: Follow-up result, Angioplasty, Binary restenosis, Target lesion revascularization, Late luminal loss E verolimus-eluting stents (EES; Xience and Promus) have exhibited benefits associated with a favorable vascular response compared to sirolimus-eluting stents (SES; Cypher BxV and Select+), owing to their advanced drug-eluting stent (DES) technology that consists of the revised thin and flexible stent platform, anti-thrombogenic fluoropolymer, and drug. 1,2) The biolimus-eluting stent (BES; Nobori) also showed a better midterm intravascular response compared to SES, owing to its properties such as being a biodegradable polymer and the highest lipophilicity among the limus analogues. 3,4) However, despite these advanced aspects of EES and BES compared with the former evidence-based first generation "-limus" DES, that is, SES, prospective randomized trials have not demonstrated significantly better midterm angiographic outcomes for either EES 5,6) or BES 7,8) in terms of binary in-stent restenosis, TLR, or mean magnitude of in-stent late luminal loss compared to those of SES.In the present study, we conducted a retrospective comparison to examine the impact of the advances in coronary stent technology, represented by improved intravascular and pathological findings of either EES or BES over SES 1-4) on the overall midterm angiographic outcomes. For this purpose, 3420 lesions angiographically followed-up ...

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Section: Discussioncontrasting

confidence: 75%

Propensity-Score Matched Comparison of Midterm Angiographic Outcomes of Sirolimus- Versus Everolimus- and Biolimus-Eluting Stents for <i>De Novo</i> Coronary Stenosis

et al. 2017

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“…Therefore, the FMJ approach with new DES seems to have better long-term outcomes compared with previous DES. However, most randomized trials comparing sirolimus-eluting stents with everolimus-eluting stents showed similar efficacy and safety outcomes [15,16]. In our study, sirolimus-eluting stents were predominantly used.…”

Section: Discussionmentioning

confidence: 67%

Long‐term (8 year) outcomes and predictors of major adverse cardiac events after full metal jacket drug‐eluting stent implantation

Lee

Ahn

Lee

et al. 2014

Cathet Cardio Intervent

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Objectives: We examined long-term outcomes and predictors of major adverse cardiac events after the full metal jacket (FMJ) stent implantation. Background: The FMJ procedure has been used to treat diffuse coronary artery disease (CAD), but long-term outcomes remain unknown. Methods: The study population consisted of 347 consecutive patients (352 lesions) who had been treated for de novo diffuse CAD with FMJ stents (stent length 60 mm). Results: The mean age was 61.0 6 10.1 years, and the stent length was 71.9 6 13.7 mm. The procedural success rate was 97.7%. Major in-hospital complications (one death and two acute stent thromboses) occurred in three patients (0.7%). The median follow-up was 101 months (interquartile range, 95-108 months). During follow-up, there were 60 deaths (33 cardiac), 20 myocardial infarctions, and 94 revascularizations. Definite stent thrombosis occurred in 12 patients. The eventfree survival rate for cardiac death, cardiac death/myocardial infarction, or cardiac death/ myocardial infarction/target lesion revascularization was 90.5 6 1.6, 85.8 6 1.9, and 71.6 6 2.5% at 8 years, respectively. Left ventricular dysfunction (ejection fraction < 45%) was an independent predictor of cardiac death (OR: 4.88; 95% CI: 1.81-13.13; P 5 0.002). Left ventricular dysfunction and a stent length > 80 mm were significantly related to cardiac death/myocardial infarction. Likewise, a stent length > 80 mm was an independent predictor of cardiac death/myocardial infarction/target lesion revascularization (OR: 2.45; 95% CI: 1.16-5.19; P 5 0.019). Conclusion: Long-term outcomes appear favorable after FMJ procedures, and left ventricular dysfunction and a stent length > 80 mm are major predictors of major adverse cardiac events. These findings might be useful in identifying the most suitable treatments for patients with very diffuse CAD. V C 2013 Wiley Periodicals, Inc.

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“…The designs and the 3‐year clinical outcomes of RESET and NEXT have been previously described in detail 5, 6, 7. In short, both RESET and NEXT are prospective, multicenter, randomized “DES versus DES” trials, in which eligible patients were randomly assigned to undergo percutaneous coronary intervention (PCI) with either everolimus‐eluting stents (EES; Xience V, Abbott Vascular, CA/PROMUS, Boston Scientific, MA) or sirolimus‐eluting stents (Cypher/Cypher select/Cypher Select‐plus; Cordis Corporation, Johnson and Johnson, NJ) in the RESET, and with either biolimus‐eluting stents (Nobori, Terumo, Tokyo) or EES in the NEXT.…”

Section: Methodsmentioning

confidence: 99%

“…Qualitative and quantitative coronary angiography (QCA) were assessed utilizing CAAS 5.9 (Pie Medical Imaging, Maastricht, Netherlands). Details of the angiographic analysis were previously presented 5, 6. In a subset of patients enrolled in the angiographic substudy, follow‐up angiography was performed between 240 and 365 days after the index PCI procedure in both the RESET and NEXT trials 7.…”

Section: Methodsmentioning

confidence: 99%

Impact of Angiographic Residual Stenosis on Clinical Outcomes After New‐Generation Drug‐Eluting Stents Implantation: Insights From a Pooled Analysis of the RESET and NEXT Trials

Watanabe

Morimoto

Shiomi

et al. 2018

JAHA

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BackgroundPrevious intravascular ultrasound studies suggested the association of stent underexpansion with increased risk of stent thrombosis and restenosis. However, no previous study has addressed the association of the suboptimal angiographic result with target‐lesion revascularization (TLR) in patients receiving new‐generation drug‐eluting stents (DES).Methods and Results RESET (Randomized evaluation of sirolimus‐eluting versus everolimus‐eluting stent trial) and NEXT (NOBORI biolimus‐eluting versus XIENCE/PROMUS everolimus‐eluting stent trial) are prospective, multicenter, randomized “DES versus DES” trials; 3196 patients and 3235 patients were enrolled in the RESET and NEXT, respectively. Using the pooled individual patient‐level data, the current study population consisted of 3679 patients who received single‐lesion treatment using new‐generation DES such as everolimus‐eluting stent and biolimus‐eluting stent. The study population was divided into 3 groups according to the residual in‐stent % diameter stenosis (%DS) after stent implantation by offline quantitative coronary angiography assessed in a core angiographic laboratory (optimal group: %DS <10%, intermediate group: %DS=10% to 20%, suboptimal group: %DS ≧20%). The cumulative 3‐year incidence of TLR was significantly higher in the suboptimal group than in the intermediate and optimal groups (9.8% versus 5.8% versus 5.7%, log‐rank P=0.004). Even after adjusting for the clinical, angiographic, and procedural characteristics, the excess TLR risk of the suboptimal group relative to the optimal group remained significant (hazard ratio: 1.65, 95% confidence interval, 1.14–2.41, P=0.009). The excess TLR risk of the suboptimal group relative to the optimal group was consistently seen across all the subgroups including heavy calcification.ConclusionsThe residual angiographic in‐stent %DS ≥20% was associated with increased risk for TLR in patients treated with the new‐generation DES.

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Comparison of Everolimus-Eluting and Sirolimus-Eluting Coronary Stents

Cited by 147 publications

References 24 publications

Propensity-Score Matched Comparison of Midterm Angiographic Outcomes of Sirolimus- Versus Everolimus- and Biolimus-Eluting Stents for <i>De Novo</i> Coronary Stenosis

Propensity-Score Matched Comparison of Midterm Angiographic Outcomes of Sirolimus- Versus Everolimus- and Biolimus-Eluting Stents for <i>De Novo</i> Coronary Stenosis

Long‐term (8 year) outcomes and predictors of major adverse cardiac events after full metal jacket drug‐eluting stent implantation

Impact of Angiographic Residual Stenosis on Clinical Outcomes After New‐Generation Drug‐Eluting Stents Implantation: Insights From a Pooled Analysis of the RESET and NEXT Trials

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