Head-to-Head Comparison of Drug-Eluting Stents Shows Few Differences

Peggy Peck

November 15, 2003

Nov. 14, 2003 (Orlando) — Results of a small retrospective analysis comparing the sirolimus-eluting stent Cypher (Cordis) to the investigational paclitaxel-eluting stent Taxus (Boston Scientific) in complex coronary lesions indicates that both stents are comparable in terms of target vessel revascularization, major adverse coronary events (MACE), and subacute stent thrombosis, according to principal investigator Abdul Razakjr Omar, MD, from the National University Hospital, Singapore.

There was, however, a trend toward lower 30-day MACE rates in the Taxus group compared with the Cypher group (8% vs. 15.5%), but the trend was not sustained at six months. Moreover, there was a statistically significant larger mean reference diameter (2.83 vs. 2.68) and postminimal luminal diameter (2.87 vs. 266) in the Taxus group ( P < .001 for both comparisons). Yet, at six months "there was significant difference in clinical outcomes even though the patients in the Cypher group had more complex lesions," he said.

Dr. Omar presented his results here at a drug-eluting stent (DES) abstract session at the American Heart Association (AHA) Scientific Sessions. Given the similarities between the two stents, he told Medscape, "I think we will be using Taxus because of the price. But for small vessels or complex lesions, I think Cypher may be better." Taxus is less expensive than Cypher, which is currently the only DES approved by the Food and Drug Administration.

Dr. Omar reviewed the outcomes of 145 patients: 58 received Cypher stents and 87 received the Taxus Express SR (slow-release formulation) stent. The mean age of patients was 56.8 years and 79.1% were men. Twenty-seven percent of the patients had diabetes. Cypher patients had a combined antiplatelet regimen of aspirin and clopidogrel (three months for the Cypher patients and six months for the Taxus patients). In both Cypher and Taxus patients there was discretionary use of glycoprotein IIb/IIIa inhibitors. Dr. Omar and colleagues assessed six-month outcomes.

Ninety-six percent of the target lesions were de novo while 4% had undergone previous percutaneous coronary intervention. Simultaneous double vessel percutaneous coronary interventions were performed in 24% of the Cypher patients and 13.8% of the Taxus patients. Overlapped stenting was performed in 17.2% of the Cypher patients and 13.8% of Taxus patients.

At 30 days, revascularization of the target vessel was required in two patients — one in each group — and one Taxus patient developed subacute stent thrombosis a week after the procedure. At six months, the MACE rate in the Taxus arm was 2.4% compared with 1.9% in the Cypher arm.

Sidney Smith, MD, professor of medicine at the University of North Carolina in Chapel Hill and former chief science officer of the AHA, told Medscape that studies such as the one by Dr. Omar and a number of registries "are adding to our knowledge about DES," and it appears that both Taxus and Cypher will be useful. Dr. Smith was not involved in the study.

AHA and the American College of Cardiology are beginning preliminary discussions about possible guidelines for the use of DES, Dr. Smith said. "I'm on the committee that is looking at this issue, but we are just at the earliest stage."

AHA 2003 Scientific Sessions: Abstract 2432. Presented Nov. 11, 2003.

Reviewed by Charlotte E. Grayson, MD

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