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Sirolimus-eluting stents beat bare metal stents for total coronary occlusion

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Outcomes are better for patients with total coronary artery occlusions when percutaneous coronary intervention is performed with sirolimus-eluting stents rather than with bare metal stents, according to an Italian study.

The researchers note in their report published ahead of print on June 20 by the European Heart Journal that PCI with bare metal stents in total coronary occlusions is associated with a higher rate of restenosis than in subtotal stenoses. While preliminary evidence indicates that results are better with drug-eluting stents, firm data are scarce.

Dr. Paolo Rubartelli at the Ospedale Villa Scassi in Genova, Italy, and colleagues conducted a multicenter trial to compare angiographic and clinical outcomes after implantation of bare metal stents or sirolimus-eluting stents in 152 patients with coronary total occlusions. Upon successful recanalization, 78 had bare metal stents implanted while 74 were assigned to sirolimus-eluting stents.

Angiographic follow-up was obtained in 128 patients (84%) at an average of 8.4 months after the procedure. “Patients treated with sirolimus-eluting stents showed, at in-segment analysis, a larger minimal luminal diameter (1.98 vs.0.98 mm, p<0.001), a lower late luminal loss (-0.06 vs. 1.11 mm, p<0.001), and lower restenosis (9.8 vs. 67.7%, p<0.001) and reocclusion (0 vs. 17%, p=0.001) rates,” Dr. Rubartelli and associates report. After 24 months, major adverse cardiac events had occurred in 50.0% of those in the bare metal stent group and 17.6% (p<0.001) of the patients given sirolimus-eluting stents -- a difference mainly attributable to a lower rate of repeat revascularizations. The investigators conclude, “Sirolimus-eluting stent implantation could be the preferred treatment option in patients with coronary total occlusion that can be recanalized percutaneously.” Reference:
Comparison of sirolimus-eluting and bare metal stent for treatment of patients with total coronary occlusions: results of the GISSOC II-GISE multicentre randomized trial

Eur Heart J 2010.