Drug-eluting stents
HCS Working Group Seminars
Macedonia Pallas Hotel, Friday 21st February 2014
Drug-eluting stents
Are they all equal?
VassilisVassilis SpanosSpanosInterventional Cardiologist, As. Director 3Interventional Cardiologist, As. Director 3rdrd Cardiology ClinicCardiology Clinic
Euroclinic Hospital, AthensEuroclinic Hospital, Athens
Drug-eluting stents
HCS Working Group Seminars
Macedonia Pallas Hotel, Friday 21st February 2014
Drug-eluting stents
How do I choose between them?
VassilisVassilis SpanosSpanosInterventional Cardiologist, As. Director 3Interventional Cardiologist, As. Director 3rdrd Cardiology ClinicCardiology Clinic
Euroclinic Hospital, AthensEuroclinic Hospital, Athens
••InIn--stent restenosis is the result of:stent restenosis is the result of:
••Inappropriate stent expansion Inappropriate stent expansion oror
Mechanisms of inMechanisms of in--stent restenosis stent restenosis
V Spanos et al. The challenge of in-stent restenosis: insights from intravascular ultrasound – review article
(Eur Heart J. 2003 Jan;24(2):138-50 )
••NeointimalNeointimal hyperplasia hyperplasia oror
••bothboth
Sirolimus-eluting stent: overcoming restenosis
Sousa JE et al. Lack of Neointimal Proliferation After Implantation of Sirolimus-Coated Stents in Human
Coronary Arteries : A Quantitative Coronary Angiography and Three-Dimensional Intravascular Ultrasound
Study ( Circulation. 2001;103:192-195 )
An unsuccessful trial - QuaDDS stent
F. Liistro, A. Colombo: Late acute thrombosis after paclitaxel eluting stent implantation
(Heart 2001;86:262-264 )
““CONCLUSIONCONCLUSION: : This single case report highlights the problem that late coronary thrombosis following paclitaxel This single case report highlights the problem that late coronary thrombosis following paclitaxel
eluting stent implantation may be an important limitation of restenosis prevention by some drug eluting stents. eluting stent implantation may be an important limitation of restenosis prevention by some drug eluting stents.
In the absence of other data, we think that combined antiplatelet treatment should be continued in the long term, In the absence of other data, we think that combined antiplatelet treatment should be continued in the long term,
unless it is contraindicatedunless it is contraindicated””
DES: a lot of different devices
EfficacyEfficacy SafetySafety
DES: a lot of different devices
EfficacyEfficacy
•• Late Lumen Loss Late Lumen Loss
•• Intimal Hyperplasia (IVUS)Intimal Hyperplasia (IVUS)
SafetySafety
•• Complete endotthelization (OCT)Complete endotthelization (OCT)
•• Incomplete apposition (IVUS)Incomplete apposition (IVUS)•• Intimal Hyperplasia (IVUS)Intimal Hyperplasia (IVUS)
•• RestenosisRestenosis
•• Repeat RevascularizationRepeat Revascularization
•• TVF (Death, CVA, MI)TVF (Death, CVA, MI)
•• Incomplete apposition (IVUS)Incomplete apposition (IVUS)
•• Stent thrombosisStent thrombosis
•• MIMI
•• TVF (Death, CVA, TVR)TVF (Death, CVA, TVR)
Late Lumen Loss with DES
Ellis SG et al: “Relationship between angiographic late loss and target lesion revascularization after coronary stent
implantation: Analysis from the TAXUS-IV trial” J Am Coll Cardiol. 2005;45(8):1193-1200
0.09mm
0.31mm
Taxus vs. Cypher – REALITY study
MC. Morice et. al. “Sirolimus- vs paclitaxel-eluting stents in de novo coronary artery lesions: the
REALITY trial: a randomized controlled trial” JAMA 2006: 295; 895-904
Taxus vs. Cypher: SIRTAX study
CLINICAL FU onlyCLINICAL FU only
MACE at 9 months was MACE at 9 months was 6.2%6.2% in the in the
Cypher vs. Cypher vs. 10.8%10.8% in the Taxus group in the Taxus group
S. Windecker et.al. “Sirolimus-eluting and paclitaxel-eluting stents for coronary revascularization”
N Engl J Med 2005;353:653-662
Cypher vs. Cypher vs. 10.8%10.8% in the Taxus group in the Taxus group
((p=0.009p=0.009) )
Difference driven by a lower rate of Difference driven by a lower rate of
TLR (4.8% vs. 8.3%. p=0.03)TLR (4.8% vs. 8.3%. p=0.03)
RRestenosisestenosis 6.66.6% vs.% vs. 11.711.7%% ((pp=0.02)=0.02)
Taxus vs. Cypher stent: small vessels
Lesions in vessels<2.8mm received Lesions in vessels<2.8mm received
either Taxus stents (n=180) oreither Taxus stents (n=180) or
Cypher (n=180) Cypher (n=180)
Taxus stents did not reach theTaxus stents did not reach the nonnon--
J. Mehilli et.al. “Randomized trial of paclitaxel- and sirolimus-eluting stents in small coronary vessels”
Eur Heart J 2006;27:260-266
Taxus stents did not reach theTaxus stents did not reach the nonnon--
inferiorityinferiority marginmargin ofof 0.16mm0.16mm late late
lumen losslumen loss
RRestenosis estenosis rate rate waswas 19.0% 19.0% (Taxus) (Taxus)
vs.vs. 11.4% 11.4% (Cypher, p(Cypher, p=0.047)=0.047)
TTLR was LR was 14.7% 14.7% vs.vs. 6.6% 6.6%
respectivelyrespectively ((pp=0.008)=0.008)
Taxus vs. Cypher: ISAR-DIABETES250 250 ptspts with DM randomly assigned with DM randomly assigned
to receive Taxus or Cypher stentsto receive Taxus or Cypher stents
InIn--segment late luminal loss was segment late luminal loss was
0.24mm greater in the Taxus stent 0.24mm greater in the Taxus stent
group (p=0.002)group (p=0.002)
A. Dibra et.al. “Paclitaxel-eluting or sirolimus-eluting stents to prevent restenosis in diabetic
patients” N Engl J Med 2005;353:663-670
group (p=0.002)group (p=0.002)
InIn--segment restenosis rate was segment restenosis rate was
16.5% for Taxus vs. 6.9% for 16.5% for Taxus vs. 6.9% for
Cypher group (p=0.03)Cypher group (p=0.03)
TLR rate was 12.0% for Taxus vs. TLR rate was 12.0% for Taxus vs.
6.4% for Cypher group (p=0.13). 6.4% for Cypher group (p=0.13).
DES: a lot of different devices
EfficacyEfficacy
•• Late Lumen Loss Late Lumen Loss
•• Intimal Hyperplasia (IVUS)Intimal Hyperplasia (IVUS)
SafetySafety
•• Complete endotthelization (OCT)Complete endotthelization (OCT)
•• Incomplete apposition (IVUS)Incomplete apposition (IVUS)•• Intimal Hyperplasia (IVUS)Intimal Hyperplasia (IVUS)
•• RestenosisRestenosis
•• Incomplete apposition (IVUS)Incomplete apposition (IVUS)
•• Repeat RevascularizationRepeat Revascularization
•• TVF (Death, CVA, MI)TVF (Death, CVA, MI)
•• Stent thrombosisStent thrombosis
•• MIMI
•• TVF (Death, CVA, TVR)TVF (Death, CVA, TVR)
Offsetting impact of ST and restenosis
on the occurrence of death/MI
G. Stone et.al. “Offsetting impact of thrombosis and restenosis on the occurrence of death and
myocardial infarction after paclitaxel-eluting and bare metal stent implantation ”
Circulation 2007 Jun 5;115(22):2842-7
Late stent thrombosis
E. McFadden et al. “Late thrombosis in DES after discontinuation of antiplatelet therapy”
Lancet.2004; 364:1519-1521
DES: a lot of different devices
EfficacyEfficacy
•• Late Lumen Loss Late Lumen Loss
•• Intimal Hyperplasia (IVUS)Intimal Hyperplasia (IVUS)
SafetySafety
•• Complete endotthelization (OCT)Complete endotthelization (OCT)
•• Incomplete apposition (IVUS)Incomplete apposition (IVUS)•• Intimal Hyperplasia (IVUS)Intimal Hyperplasia (IVUS)
•• RestenosisRestenosis
•• Incomplete apposition (IVUS)Incomplete apposition (IVUS)
•• Repeat RevascularizationRepeat Revascularization
•• TVF (Death, CVA, MI)TVF (Death, CVA, MI)
•• Stent thrombosisStent thrombosis
•• MIMI
•• TVF (Death, CVA, TVR)TVF (Death, CVA, TVR)
Sirolimus-eluting stent: overcoming restenosis
Sousa JE et al. Lack of Neointimal Proliferation After Implantation of Sirolimus-Coated Stents in Human
Coronary Arteries : A Quantitative Coronary Angiography and Three-Dimensional Intravascular Ultrasound
Study ( Circulation. 2001;103:192-195 )
Taxus vs. Cypher – REALITY study
More stent thromboses with
Taxus (13, 1.9%) than Cypher
MC. Morice et. al. “Sirolimus- vs paclitaxel-eluting stents in de novo coronary artery lesions: the
REALITY trial: a randomized controlled trial” JAMA 2006: 295; 895-904
Taxus (13, 1.9%) than Cypher
(5, 0.7%), although the
difference did not reach
statistical significance
DES: a lot of different devices
EfficacyEfficacy
•• Late Lumen Loss Late Lumen Loss
•• Intimal Hyperplasia (IVUS)Intimal Hyperplasia (IVUS)
SafetySafety
•• Complete endotthelization (OCT)Complete endotthelization (OCT)
•• Incomplete apposition (IVUS)Incomplete apposition (IVUS)•• Intimal Hyperplasia (IVUS)Intimal Hyperplasia (IVUS)
•• RestenosisRestenosis
•• Incomplete apposition (IVUS)Incomplete apposition (IVUS)
•• Repeat RevascularizationRepeat Revascularization
•• TVF (Death, CVA, MI)TVF (Death, CVA, MI)
•• Stent thrombosisStent thrombosis
•• MIMI
•• TVF (Death, CVA, TVR)TVF (Death, CVA, TVR)
Incomplete strut coverage in Late STKo et al Davlouros et al Miyazaki et al Guagliumi et al Alfonso et al
n 18 DES 7 DES 6 DES 18 DES 8 BMS/ 7 DES
DES type 14 SES/ 3
PES/ 1
EES
N/A 5SES/ 1PES 6 SES/ 10 PES/
1 EES/ 1 ZES
N/A
EES
Interval
(months)
40±20 8 (3-62) 37±12 21 (6-60) 43±51
Uncovered
struts
- 32% 29% 12.3% -
Patients with
uncovered
struts
50% 100% 100% 83.3% 60%
Ko et al, Int J Cardiovasc Img 2012, Davlouros et al, Circ J 2011, Miyazaki et al, Circ J 2012, Guagliumi et al, JACC
Intv 2012, Anfonso et al, Heart 2012
DES coverage by OCT
Papayannis AC et al, CCI 2012, Gutierrez-Chico JL et al, EHJ CI 2012
DES coverage by OCT: Discrepancy between
differences in coverage and clinical outcome
DES: a lot of different devices
EfficacyEfficacy
•• Late Lumen Loss Late Lumen Loss
•• Intimal Hyperplasia (IVUS)Intimal Hyperplasia (IVUS)
SafetySafety
•• Complete endotthelization (OCT)Complete endotthelization (OCT)
•• Incomplete apposition (IVUS)Incomplete apposition (IVUS)•• Intimal Hyperplasia (IVUS)Intimal Hyperplasia (IVUS)
•• RestenosisRestenosis
•• Incomplete apposition (IVUS)Incomplete apposition (IVUS)
•• Repeat RevascularizationRepeat Revascularization
•• TVF (Death, CVA, MI)TVF (Death, CVA, MI)
•• Stent thrombosisStent thrombosis
•• MIMI
•• TVF (Death, CVA, TVR)TVF (Death, CVA, TVR)
DES: a lot of different devices
DES proven superior to BMS and DES proven superior to BMS and
used extensively in everyday practice used extensively in everyday practice
in USA & Europein USA & Europe
Cypher stentCypher stent
Taxus stentTaxus stent
DES proven superior to BMSDES proven superior to BMS
DES proven nonDES proven non--inferior to either inferior to either
Cypher or Taxus Cypher or Taxus
DES tested in clinical studies and/or DES tested in clinical studies and/or
used in everyday practice in Europeused in everyday practice in Europe
The Endeavor stent: ENDEAVOR II Study
TVFTVF at 9 months was at 9 months was
reduced from 15.1% to reduced from 15.1% to
7.9% with the Endeavor 7.9% with the Endeavor
((pp=0.0001)=0.0001)
FajadetFajadet J.J. et.al. “et.al. “Randomized, doubleRandomized, double--blind, multicenter study of the Endeavor blind, multicenter study of the Endeavor zotarolimuszotarolimus--eluting eluting
phosphorylcholinephosphorylcholine--encapsulated stent for treatment of native coronary artery lesions: clinical and encapsulated stent for treatment of native coronary artery lesions: clinical and
angiographic results of the ENDEAVOR II trial” Circulation 2006; 114angiographic results of the ENDEAVOR II trial” Circulation 2006; 114: 798: 798--806806
((pp=0.0001)=0.0001)
The rate of inThe rate of in--segment segment
restenosis was reduced from restenosis was reduced from
35.0% to 13.2% with 35.0% to 13.2% with
Endeavor (Endeavor (pp<0.0001)<0.0001)
End points Endeavor
(n=282)
Cypher
(n=94)
p
In-stent mean lumen diameter (mm) 2.08 2.52 <0.001
In-segment mean lumen diameter (mm) 1.92 2.16 <0.001
In-stent diameter stenosis (%) 24.3 11.0 <0.001
The Endeavor stent: ENDEAVOR III Study
In-stent diameter stenosis (%) 24.3 11.0 <0.001
In-segment diameter stenosis (%) 29.9 23.9 <0.001
In-stent binary restenosis (%) 9.2 2.1 0.02
In-segment binary restenosis (%) 11.7 4.3 0.04
In-stent late loss (mm) 0.60 0.15 <0.001
In-segment late loss (mm) 0.34 0.13 <0.001
Kandzari D.Kandzari D. et.al. “et.al. “Comparison of zotarolimusComparison of zotarolimus--eluting and sirolimuseluting and sirolimus--eluting stents in patients with eluting stents in patients with
native coronary artery disease: a randomized controlled trial” JACC 2006; 46native coronary artery disease: a randomized controlled trial” JACC 2006; 46: 2440: 2440--4747
Late Lumen Loss with DES
Ellis SG et al: “Relationship between angiographic late loss and target lesion revascularization after coronary stent
implantation: Analysis from the TAXUS-IV trial” J Am Coll Cardiol. 2005;45(8):1193-1200
0.15mm
0.60mm
End points Endeavor
(n=1162)
Cypher
(n=1170)
p
The Endeavor stent: SORT OUT III Study
(n=1162) (n=1170)
MACE (Cardiac death, MI, TVR) 113 (10.0%) 53 (5.0%) <0.0001
TLR 71 (6.0%) 20 (2.0%) <0.0001
All cause mortality 51 (4.0%) 32 (3.0%) 0.035
RasmunsenRasmunsen K.K. et.al. “et.al. “Efficacy and safety of zotarolimus-eluting and sirolimus-eluting coronary stents
in routine clinical care (SORT OUT III): a randomised controlled superiority trial” JACC 2006; 46” JACC 2006; 46: :
24402440--4747
Biolimus vs Sirolimus eluting stents
5 years follow up of the LEADERS Trial5 years follow up of the LEADERS Trial857 857 ptspts with BES vs. 850 with SESwith BES vs. 850 with SES
P. P. SerruysSerruys, TCT 2012, TCT 2012
Biolimus vs Sirolimus eluting stents
5 years follow up of the LEADERS Trial5 years follow up of the LEADERS Trial857 857 ptspts with BES vs. 850 with SESwith BES vs. 850 with SES
P. P. SerruysSerruys, TCT 2012, TCT 2012
Biolimus vs Sirolimus eluting stents
5 years follow up of the LEADERS Trial5 years follow up of the LEADERS Trial857 857 ptspts with BES vs. 850 with SESwith BES vs. 850 with SES
P. P. SerruysSerruys, TCT 2012, TCT 2012
DES: Different approaches
Αντίδραση υπερευαισθησίας
J. Nebeker et al. (JACC. 2006;47:175-181)
Paclitaxel vs. Everolimus eluting stents2 years follow up of the SPIRIT IV Trial2 years follow up of the SPIRIT IV Trial
2458 2458 ptspts with EES vs. 1229 with PESwith EES vs. 1229 with PES
Stone G. et Stone G. et al “2 year follow up from the SPIRIT IV al “2 year follow up from the SPIRIT IV Trial”Trial”J Am Coll Cardiol 2011:28;58(1):19-25
EES vs. SES: SORT OUT IV Trial1390 1390 ptspts (1805 lesions) with EES vs. 1384pts (1779 lesions) with SES(1805 lesions) with EES vs. 1384pts (1779 lesions) with SES
Jensen L. et Jensen L. et al al Circulation.2012; 125: 1246-1255
Less ST with Everolimus
eluting stents
4 years Registry, 12339 4 years Registry, 12339 ptspts::
4212 4212 lsnslsns EES EES -- 4308 PES 4308 PES -- 3819 SES 3819 SES
RaberRaber L. et L. et al “al “Very Late Coronary Stent Thrombosis of a Newer-Generation Everolimus-Eluting
Stent Compared With Early-Generation Drug-Eluting Stents” Circulation.2012; 125: 1110-1121
Lower risk of cardiac death/MI with Lower risk of cardiac death/MI with
EES compared with PES (hazard EES compared with PES (hazard
ratio:0.65; 95% confidence interval, ratio:0.65; 95% confidence interval,
0.560.56––0.75;0.75; PP<0.0001)<0.0001)
ZES Resolute vs. EES
13 months follow up of the RESOLUTE All 13 months follow up of the RESOLUTE All ComersTrialComersTrial1140 1140 ptspts with ZES vs. 1152 with EESwith ZES vs. 1152 with EES
0.15mm
0.06mm
SerruysSerruys P. et P. et al “al “Comparison of Zotarolimus-Eluting and Everolimus-Eluting Coronary Stents” ”
N Engl J Med 2010; 363:136-146
0.06mm
New DES have to present convincing data
S. Windecker et al. (PCR 2013)
The CoStar stent: PISCES Study
P. Serruys et al. ( JACC 2005;46:253-260 )
Lowest in-stent late loss (0.38 mm, and 0.30 mm, p <0.01) and volume
obstruction (8% and 5%, p <0.01) in the 30-day release groups (10µg, 30µg).
8.6% MACE for DES: death 0.5%, myocardial infarction 2.7%, and TLR 5.3%.
•DES are complex devices with different characteristics and
should be judged from their results as regards efficacy and
safety
CONCLUSIONS
•There are second generation DES that have shown superiority
compared to first generation (Cypher or Taxus) stents
•DES technology will continue to evolve aiming to devices with
higher efficacy and safety
Thank you for your attention!Thank you for your attention!
www.mathetinkardiasou.grwww.mathetinkardiasou.gr
The Endeavor stent: More safe?
ZES SES PES
1 year follow up of the ZEST Trial1 year follow up of the ZEST Trial2645 2645 ptspts randomized to ZES, SES, PESrandomized to ZES, SES, PES
Park D.Park D. et.al. “et.al. “Comparison of Zotarolimus-Eluting Stents With Sirolimus- and Paclitaxel-Eluting
Stents for Coronary Revascularization : The ZEST (Comparison of the Efficacy and Safety of
Zotarolimus-Eluting Stent with Sirolimus-Eluting and PacliTaxel-Eluting Stent for Coronary
Lesions) Randomized Trial” JACC 2010; 56” JACC 2010; 56: 1187: 1187--95 95
An unsuccessful trial: SCORE
E. Grube et al. ( JACC 2004;44:1368-1372 )
QuaDDS stent
7,4% restenosis rate (32,7%),
but 10,3% stent thrombosis (0,7%)
Loss of side branches after
Taxus stent implantation
G. Stone, TCT 2005
2 years follow up of the COMPARE Trial2 years follow up of the COMPARE Trial897pts (1286 lesions) with EES vs. 903pts (1294 897pts (1286 lesions) with EES vs. 903pts (1294 lsnslsns) with PES) with PES
Smits P. et Smits P. et al “2 year follow up al “2 year follow up of a Randomized Controlled Trial of EES and PES for Coronary
Revascularization in Daily Practice” J Am Coll Cardiol. 2011;58(1):11-18
Paclitaxel vs. Everolimus eluting stents
2 years follow up of the SPIRIT III Trial2 years follow up of the SPIRIT III Trial669 lesions with EES vs. 333 with PES669 lesions with EES vs. 333 with PES
0.28mm
Stone G. et Stone G. et al Randomized Comparison of al Randomized Comparison of EverolimusEverolimus--Eluting and Eluting and PaclitaxelPaclitaxel--Eluting Eluting
StentsStents. Circulation. 2009;119:680. Circulation. 2009;119:680--686686
Treatment with Treatment with EverolimusEverolimus stent resulted in a trend toward fewer restent resulted in a trend toward fewer re--
interventions (TLR), fewer MIs and reduction in the composite of death/MI interventions (TLR), fewer MIs and reduction in the composite of death/MI
(4.8% vs. 8.1%, relative risk: 0.60, 95% CI:(4.8% vs. 8.1%, relative risk: 0.60, 95% CI: 0.36 to 0.99, p=0.055)0.36 to 0.99, p=0.055)
0.14mm
0.28mm
Offsetting impact of ST and restenosis
on the occurrence of death/MI
G. Stone et.al. “Offsetting impact of thrombosis and restenosis on the occurrence of death and
myocardial infarction after paclitaxel-eluting and bare metal stent implantation ”
Circulation 2007 Jun 5;115(22):2842-7
Offsetting impact of ST and restenosis
on the occurrence of death/MI
G. Stone et.al. “Offsetting impact of thrombosis and restenosis on the occurrence of death and
myocardial infarction after paclitaxel-eluting and bare metal stent implantation ”
Circulation 2007 Jun 5;115(22):2842-7
Taxus vs. Cypher – REALITY study
MC. Morice et. al. “Sirolimus- vs paclitaxel-eluting stents in de novo coronary artery lesions: the
REALITY trial: a randomized controlled trial” JAMA 2006: 295; 895-904
Manufacturer Name Drug Stent material Polymer Status
Abbott ZoMaxx Zotarolimus Tantalum/St steel Durable —
Sorin Janus Tacrolimus Stainless steel None CE
Conor CoStar Paclitaxel Cobalt chromium Bioabsorbable CE
DES: a lot of different devices
Conor CoStar Paclitaxel Cobalt chromium Bioabsorbable CE
Guidant Xience V Everolimus Cobalt chromium Durable CE
Medtronic Endeavor Zotarolimus Cobalt chromium Durable CE
Terumo Nobori Biolimus-A9 Stainless steel Bioabsorbable —
The bioabsorbable stent: ABSORB
Study
6-month follow-up 26 lesions
In-stent diameter stenosis (%) 27
In-stent late loss (mm) 0.44
In-stent restenosis (%) 11.5
Serruys P. American College of Cardiology 2007 Scientific Sessions; March 24, 2007.
In-stent restenosis (%) 11.5
A stent A stent made from a polylactic acid (PLA) backbone, with an everolimus/PLA made from a polylactic acid (PLA) backbone, with an everolimus/PLA
coating coating expected toexpected to dissolve dissolve completely completely after 12after 12--18 month18 monthss
LLate loss and restenosis were greater than with current ate loss and restenosis were greater than with current DESDES, , probably due toprobably due to the the
15% shrinkage seen with the new stent15% shrinkage seen with the new stent
DES: a lot of different devices
DES proven superior to BMS and DES proven superior to BMS and
used extensively in everyday practice used extensively in everyday practice
in USA & Europein USA & Europe
Cypher stentCypher stent
Taxus stentTaxus stent
DES proven superior to BMSDES proven superior to BMS
DES proven nonDES proven non--inferior to either inferior to either
Cypher or Taxus Cypher or Taxus
DES tested in clinical studies and/or DES tested in clinical studies and/or
used in everyday practice in Europeused in everyday practice in Europe
Taxus vs. Cypher stent: long lesions
LLesionsesions ≥≥ 24mm 24mm treatedtreated withwith longlong CypherCypher (223)(223), Taxus, Taxus (194), (194), oror BMBM stentsstents
Mean Lesion length treated with Cypher stent: 36.0 Mean Lesion length treated with Cypher stent: 36.0 ±± 14.9mm14.9mm
Mean Lesion length treated with Taxus stent: 36.3 Mean Lesion length treated with Taxus stent: 36.3 ±± 14.5mm 14.5mm
6 month in6 month in--segment restenosis rates were higher for Taxus (21.3%) than segment restenosis rates were higher for Taxus (21.3%) than
Y. Kim et.al. “Comparison of sirolimus-eluting stent, paclitaxel-eluting stent, and bare metal stent in
the treatment of long coronary lesions” Cath Cardiovasc Interv 2006;67(2):181-187
6 month in6 month in--segment restenosis rates were higher for Taxus (21.3%) than segment restenosis rates were higher for Taxus (21.3%) than
Cypher group (9.3%, p=0.002)Cypher group (9.3%, p=0.002)
6 month 6 month MACE rate was similar: 13.0% for Cypher and 15.7% for Taxus MACE rate was similar: 13.0% for Cypher and 15.7% for Taxus
stentstent
End point XIENCE V Taxus P
In-segment late loss (mm) 0.14 0.28 <0.001 (noninferiority)
0.004 (superiority)
In-stent late loss (mm) 0.16 0.31 0.006
The Xience V stent: SPIRIT III Study
Stone G. American College of Cardiology 2007 Scientific Sessions. March 24, 2007
In-stent late loss (mm) 0.16 0.31 0.006
In-segment binary
restenosis (%)
4.7 8.9 0.07
Target vessel failure 7.2 9.0 <0.0001 (noninferiority)
MACE 4.6 8.1 0.025 (superiority)
PES vs. SES: REALITY study
MC. Morice. April 2005. tctmd.com