Sirolimus-Eluting Stents May Outperform Paclitaxel-Eluting Stents

Martha Kerr

March 17, 2006

March 17, 2006 (Atlanta) — The results from a large meta-analysis comparing the 2 drug-eluting stents on the market, a sirolimus-eluting stent (SES; Cypher, Cordis Corp, a Johnson and Johnson company, Miami Lakes, Florida) and the paclitaxel-eluting stent (PES; Taxus, Boston Scientific Corp, Natick, Massachusetts) suggests that SES is associated with lower rates of in-stent restenosis and other major adverse cardiovascular events (MACE).

The analysis was conducted using collective data from 2 meta-analyses — a direct comparison meta-analysis of data from 6 randomized, head-to-head comparison trials and an indirect comparison meta-analysis comparing the 2 stents from 9 other studies. Collectively, the studies included a total of 5854 patients; 2852 patients received SES and 3002 patients were treated with PES.

The results were presented here this week at the 55th annual scientific session of the American College of Cardiology by Antonio Abbate, MD, from the Internal Medicine Residency Categorical Program at the Medical College of Virginia in Richmond.

Dr. Abbate reported that in the entire patient population, compared with PES, use of SES was associated with significant reductions in binary angiographic restenosis and rates of target vessel revascularization. Overall, SES was associated with a 38% relative risk reduction in restenosis ( P < .0001) and a 34% risk reduction in revascularization ( P = .0008) compared with patients treated with PES. The results were significant within each meta-analysis.

"I think the results of this combined meta-analysis [are] reassuring because we now know that all available data, not only the direct comparison, but also the indirect comparison, confirms the finding of a superiority of sirolimus-eluting stent over paclitaxel-eluting stent," Dr. Abbate concluded. He cautioned, however, that the decision to use one stent over the other should be made in concert with other factors, such as the polymer platform, cost, and device availability.

In an interview with Medscape, Campbell Rogers, MD, director of the Cardiac Catheterization Laboratory at Brigham and Women's Hospital and professor of cardiovascular medicine at Harvard University School of Medicine in Boston, Massachusetts, said that he and his colleagues favor SES, because the device "offers better efficacy and may offer more safety." Safety considerations are paramount, however, and are still being debated, he pointed out.

"The Taxus stent may be more flexible but it has a higher rate of in-stent restenosis," Dr. Rogers commented. "With experience, interventionists can learn to use the Cypher stent as easily as the Taxus stent."

Dr. Rogers noted that the advances in interventional cardiology have brought great attention to the field, as noted by the fact that the College cosponsored the first Innovation in Intervention: i2 Summit, an annual meeting, dedicated to research in the interventional field.

ACC 55th Scientific Session: Abstract 2912-74. Presented March 13, 2006.

Reviewed by Ariana Del Negro

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