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Some drug-eluting stents better than others

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Results of a new meta-analysis indicate that all drug-eluting stents (DES) outperform bare metal stents (BMS) over both the short and long term, but some DES are more efficacious than others.

Furthermore, stent thrombosis risk is no higher with any DES than with a BMS. “In fact, there was a significant reduction in both short- and long-term risk of stent thrombosis with the safest DES when compared with BMS,” note the authors of the report in Circulation online May 14

Dr. Sripal Bangalore, at New York University School of Medicine, New York, and colleagues explain that the relative efficacy and safety of drug-eluting stents when compared with bare metal stents is not well defined. “Whether any one DES is measurably different in its efficacy and safety is a topic of great interest to physicians and patients,” they comment.

With that in mind, the team identified 77 randomized controlled trials with 117,762 patient-years of follow-up, comparing the currently approved drug eluting stents with each other or against a bare metal stent. The trials included sirolimus-eluting (SES), paclitaxel-eluting (PES), everolimus-eluting (EES) and zotarolimus-eluting (ZES) stents and the ZES-Resolute (ZES-R) device.

The investigators assessed efficacy, based on rates of target vessel and target lesion revascularization (TVR), and safety as indicated by rates of death, MI, and stent thrombosis, over the short term (up to 1 year) and long term.

Compared to BMS, the drug-eluting stents reduced long-term target vessel revascularization by 39% to 61%. The most effective were EES, SES and ZES-R, followed by PES and ZES

“Despite the considerable efficacy of DES at reducing the risk of in-stent restenosis, the possibility of an increased risk of stent thrombosis, especially very late stent thrombosis, has been an important safety concern with DES,” the authors point out.

In that regard, they found no increase in the risk of stent thrombosis with DES with appropriate concomitant antiplatelet therapy. In fact, the risk of stent thrombosis was reduced with the everolimus-eluting stent (EES), when compared with BMS. In addition, there was a reduction in MI risk with all DES except the paclitaxel-eluting stent, versus BMS.

Summing up, Dr. Bangalore and colleagues conclude, “DES are highly efficacious at reducing the risk of TVR without increase in any safety outcomes including stent thrombosis.”

“However,” they add, “within the DES types there were considerable differences, such that EES, SES, and ZES-R were the most efficacious and EES was the safest stent.”

SOURCE:

Short and Long-Term Outcomes with Drug Eluting and Bare Metal Coronary Stents: A Mixed Treatment Comparison Analysis of 117 762 Patient-Years of Follow-up from Randomized Trials

Circulation 2012.