Sirolimus versus paclitaxel coronary stents in clinical practice

Millauer, Niklas; Jüni, Peter; Hofmann, A.; Wandel, Simon; Bhambhani, Anupam; Billinger, Michael; Urwyler, Niklaus; Wenaweser, Peter; Hellige, G; Räber, Lorenz; Cook, Stéphane; Vogel, Rolf; Togni, Mario; Seiler, Christian; Meier, Bernhard; Windecker, Stephan

doi:10.1002/ccd.22597

Cited by 10 publications

(1 citation statement)

References 108 publications

(101 reference statements)

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“…Similar to our results, several authors failed to find differences between SES and PES in terms of restenosis, repeat revascularization, and MACE rates [16][17][18][19][20][21], whereas others have reported either a superiority [22][23][24][25][26] or only a favorable trend toward a lower frequency of TLR [27,28] in the SES group compared with PES. The heterogeneity of results across these studies might be related to differences in the baseline characteristics of the patients as well as the duration of follow-up.…”

Section: Discussionsupporting

confidence: 92%

Six-year clinical outcomes of first-generation drug-eluting stents

Tarantini

Barioli²,

Facchin³

et al. 2013

Coronary Artery Disease

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Section: Discussionsupporting

confidence: 92%

Six-year clinical outcomes of first-generation drug-eluting stents

Tarantini

Barioli²,

Facchin³

et al. 2013

Coronary Artery Disease

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Sirolimus‐ versus paclitaxel‐eluting stents for unselected patients with coronary artery disease

Park

2010

Cathet Cardio Intervent

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Millauer et al. reported that sirolimus-eluting stent (SES) decreased the incidence of major adverse cardiac events over 2 years compared with paclitaxel-eluting stent (PES) in 904 unselected patients with coronary artery stenosis [1]. In spite of a nonrandomized study design, a selection bias may be minimized, because this study has been conducted before the publication of randomized studies comparing SES and PES. The major finding of this study was in line with the previous randomized or registry studies showing the superior benefit of SES over PES in the reduction of restenosis and subsequent repeat revascularization [2]. In the meta-analysis, SES significantly reduced the risk of reintervention by 26% (P 5 0.001) and stent thrombosis by 34% (P 5 0.02) [2]. Because of this finding and anticipation of better safety and deliverability, the first generation drug-eluting stent (DES) has increasingly been exchanged with the second-generation DES in the current practices.The risk of mortality or myocardial infarction has not been affected by the type of DES. However, when it comes to the incidence of repeat revascularization, there may be a difference among the diverse DES. The previous studies having mandatory angiographic follow-up showed that the limus-analog DES decreased the late loss and reintervention rate by the stronger inhibition of neointima compared with PES [2,3]. In contrast, a randomized study without mandatory angiographic surveillance showed no difference in the clinical outcomes between SES and PES [4]. This study of Millauer et al, however, suggests that greater reduction of late loss can improve clinical outcomes by the reduction of repeat revascularization in unselected patients even when angiographic follow-up was not routinely performed.A superior benefit of SES in reduction of restenosis or repeat revascularization did not exist for a subgroup of diabetic patients. Although the mechanism is not clear, the clinical impact of SES may be less pronounced because multiple comorbidities and extensive coronary disease in diabetic patients independently influence the clinical outcomes [5]. In addition, the risk of reintervention may be underestimated, because medical treatment is occasionally adopted for complex patterns of restenosis [3]. Alternatively, antimitotic activity of limus-analog DES may be attenuated in the presence of hyperglycemia. Nonetheless, it is noteworthy that this finding of the subgroup analysis can only be regarded as exploratory. This study and all other studies showing the similarity in repeat reavascularization rate between SES and PES were performed as the post hoc subgroup analysis without adequate statistical power. In fact, results from the previous randomized studies have consistently proposed that SES may offer an angiographic and clinical advantage over PES even in patients with diabetes [6,7]. Further large randomized studies to compare diverse type of DES are required in diabetic population.

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Comparison between sirolimus- and paclitaxel-eluting stents for the treatment of older patients affected by coronary artery disease: results from a single-center allcomers registry

et al. 2011

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The treatment of elderly patients with coronary artery disease (CAD) is challenging because this population is complex and greatly expanding. Drug-eluting stents (DES) generally improve the outcome in high-risk cases. We evaluated the clinical impact of different first-generation DES, i.e., sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES), in this context. A prospective, nonrandomized, single-center, allcomers registry consecutively enrolling all patients aged ≥75 years eligible for percutaneous coronary intervention (PCI) with DES was carried out. Only one type of DES was implanted per protocol for each patient. Two groups were identified according to the type of implanted stent, i.e., SES and PES. The primary end point encompassed major adverse cardiac events (MACE), including death, myocardial infarction, and target lesion revascularization (TLR). The secondary end point encompassed the rate of definite/probable stent thrombosis and target vessel revascularization (TVR). From June 2004 to May 2008, 151 patients were enrolled. Among them, 112 (74.2%) received SES and 39 (25.8%) received PES. Baseline clinical characteristics were similar, while few angiographic features (ostial location, stent diameter, proximal reference vessel diameter) showed minor differences. At the median follow-up of 22.6 months, primary and secondary end points did not significantly differ in terms of MACE (SES 12.5% vs PES 20.5%, P = 0.3), death (SES 5.4% vs PES 7.7%, P = 0.7), myocardial infarction (SES 4.5% vs PES 10.3%, P = 0.2), TLR (SES 2.7% vs PES 2.6%, P = 1.0), stent thrombosis (SES 1.8% vs PES 5.1%, P = 0.3), and TVR (SES 1.8% vs PES 0%, P = 0.6). In this real-world population of elderly patients treated by DES-PCI for CAD, the overall efficacy and safety have been excellent in both DES, and the choice between SES and PES did not influence the clinical outcome.

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Sirolimus versus paclitaxel coronary stents in clinical practice

Abstract: SES more effectively reduced the need for repeat revascularization procedures than PES when used in routine clinical practice. The beneficial effect is maintained up to 2 years and may be less pronounced in diabetic patients.

Cited by 10 publications

References 108 publications

Six-year clinical outcomes of first-generation drug-eluting stents

Six-year clinical outcomes of first-generation drug-eluting stents

Sirolimus‐ versus paclitaxel‐eluting stents for unselected patients with coronary artery disease

Comparison between sirolimus- and paclitaxel-eluting stents for the treatment of older patients affected by coronary artery disease: results from a single-center allcomers registry

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