A new study, released as a Lancet early online publication last Friday (23rd March) has shown that over the largest data set ever analysed, Drug-Eluting Stents(DES) appear to outperform their Bare Metal Stent (BMS) forebears with lower rates of restenosis. Of the various drug coatings studied Everolimus appeared to be the only one which consistently beat bare metal over all time points out to 2 years as assessed by this single outcome measure.
This study looked at stent thrombosis rates at given time points post-implantation and compared the various DES options with each other and with bare metal “equivalents”. According to the study preamble, restenosis rates are so low that a very large data set is required in order to draw any conclusions, to which end this study, funded by the Cardiovascular Research Foundation, was performed. It drew on data from 49 randomised trials identified through Medline, Embase and Cochrane, totalling over 50000 patients with a two year follow-up. The early online publication can be found here.
The various drug-eluting stents studied included cobalt-chromium everolimus (CoCr-EES), Paclitaxel, Sirolimus and Zotarolimus.
According to the study findings:
- At 30 days CoCr-EES stent thrombosis was significantly lower than BMS.
- 1-year definite stent thrombosis was significantly lower with CoCr-EES than with BMS.
- 1-year definite stent thrombosis was significantly lower with CoCr-EES than with paclitaxel-eluting stents, permanent polymer-based sirolimus-eluting stents, phosphorylcholine-based zotarolimus-eluting stents, and Resolute zotarolimus-eluting stents.
- 2-year definite stent thrombosis was significantly lower with CoCr-EES than BMS and paclitaxel-eluting stents. No other drug-eluting stent had lower definite thrombosis rates compared with bare-metal stents at 2-year follow-up.
“The finding that CoCr-EES also reduced stent thrombosis compared with bare-metal stents, if confirmed in future randomized trials, represents a paradigm shift.”
At face value this is strong data and good news for the purveyors of drug eluting stents, especially the everolimus camp, most notably Abbott. However it is only a meta analysis and has only reported on one outcome measure according to the early online publication, so it’s rather up to the reader to decide whether thrombosis is their preferred and only measure of successful outcome.
Source: The Lancet
Reference: Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis, Tullio Palmerini MD, Giuseppe Biondi-Zoccai MD, Diego Della Riva MD, Christoph Stettler MD, Diego Sangiorgi MStat, Fabrizio D’Ascenzo MD, Prof Takeshi Kimura MD, Carlo Briguori MD, Manel Sabatè MD, Prof Hyo-Soo Kim MD, Antoinette De Waha MD, Elvin Kedhi MD, Pieter C Smits MD, Christoph Kaiser MD, Gennaro Sardella MD, Antonino Marullo MD, Ajay J Kirtane MD, Prof Martin B Leon MD, Prof Gregg W Stone MD.