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Everolimus-eluting versus paclitaxel-eluting stents in coronary artery disease.

Gregg W Stone1, Ali Rizvi, William Newman

  • 1Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY 10022, USA. gs2184@columbia.edu

The New England Journal of Medicine
|May 7, 2010

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View abstract on PubMed

Summary

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  • Biomedical And Clinical Sciences
  • Cardiovascular Medicine And Haematology
  • Cardiovascular Medicine And Haematology Not Elsewhere Classified
  • Everolimus-eluting Versus Paclitaxel-eluting Stents In Coronary Artery Disease.
    • This summary is machine-generated.

    Everolimus-eluting stents significantly reduced target-lesion failure compared to paclitaxel-eluting stents in most patients. This benefit was not observed in patients with diabetes.

    Area of Science:

    • Cardiovascular Medicine
    • Interventional Cardiology
    • Biomaterials Science

    Background:

    • Coronary everolimus-eluting stents (EES) show angiographic superiority over paclitaxel-eluting stents (PES).
    • Previous trials lacked power for clinical endpoint superiority between EES and PES.

    Purpose of the Study:

    • To compare the clinical efficacy of EES versus PES in a large patient cohort.
    • To evaluate the primary endpoint of target-lesion failure (TLF) at one year.

    Main Methods:

    • A randomized trial involving 3687 patients across 66 U.S. sites.
    • Patients received either EES or PES without routine follow-up angiography.
    • Primary endpoint: 1-year composite rate of cardiac death, target-vessel myocardial infarction, or ischemia-driven target-lesion revascularization.

    Main Results:

    • EES demonstrated superiority in reducing 1-year target-lesion failure (4.2% vs. 6.8%, P=0.001).
    • EES also showed superiority in reducing ischemia-driven target-lesion revascularization (P=0.001) and were non-inferior for cardiac death or target-vessel MI (P<0.001).
    • Lower rates of myocardial infarction (1.9% vs. 3.1%, P=0.02) and stent thrombosis (0.17% vs. 0.85%, P=0.004) were observed with EES. TLF reduction was consistent across subgroups, except in patients with diabetes (6.4% vs. 6.9%, P=0.80).

    Conclusions:

    • Everolimus-eluting stents significantly reduce target-lesion failure at one year compared to paclitaxel-eluting stents.
    • This benefit was consistent across most patient subgroups, with no significant difference observed in patients with diabetes.

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