Key result
Everolimus-eluting stents reduced 2-year major adverse cardiac events compared to paclitaxel-eluting stents in patients with target lesions and jailed side branches (6.8% vs 19.0%; P=0.03).
Why the study?
Does an everolimus-eluting stent reduce major adverse cardiac events compared to a paclitaxel-eluting stent in patients with target lesions with jailed side branches?
RCT (n=176)
Does an everolimus-eluting stent reduce major adverse cardiac events compared to a paclitaxel-eluting stent in patients with target lesions with jailed side branches?
Absolute Event Rate: 6.8% vs 19%
p-value: p=0.03
In patients with target lesions and jailed side branches, everolimus-eluting stents significantly reduced 2-year MACE compared to paclitaxel-eluting stents, driven by fewer MIs and TLRs.
May favor everolimus- over paclitaxel-eluting stents for jailed side branches; leaves open confirmation in randomized trials.
OBJECTIVE: To evaluate whether an everolimus-eluting stent (EES) with thinner stent struts and polymer results in less periprocedural myonecrosis and adverse outcomes. BACKGROUND: Higher periprocedural myocardial infarction (MI) rates have been reported with the TAXUS® EXPRESS(2) paclitaxel-eluting stent (PES) compared to the bare metal EXPRESS(2)® stent due to more frequent side branch compromise, presumably attributable to the thickness of the stent/polymer on the PES. METHODS: In the SPIRIT III trial, we identified 113 patients in the XIENCE V® EES group and 63 patients in the TAXUS EXPRESS(2) PES group who met the criteria of having a lesion with a jailed side branch (<2 mm diameter, and <50% stenosis). Two-year clinical outcomes were evaluated. RESULTS: A periprocedural increase in Creatine Kinase-MB >1× upper normal level occurred in 9.0% of EES compared to 29.7% of PES patients with jailed side branches, P = 0.01. Through 2 years, major adverse cardiac events (MACE; cardiac death, MI, or target lesion revascularization [TLR]) occurred in 6.8% of EES and 19.0% of PES jailed side branch patients (P = 0.03), with numerically lower rates of MI (2.9% vs. 10.3%, P = 0.07) and TLR (3.9% vs. 10.3%, P = 0.17) in the EES group, with comparable rates of cardiac death (1.9% vs. 1.7%, P = 1.00). CONCLUSIONS: In this post-hoc analysis of the SPIRIT III RCT, patients undergoing stenting of target lesions with jailed side branches with the thin strut and polymer XIENCE V EES compared to the thicker strut TAXUS PES had lower rates of MACE through 2 years due to fewer MIs and TLRs.
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Applegate et al. (2010) conducted an RCT in Target lesions with jailed side branches (n=176). XIENCE V everolimus-eluting stent vs. TAXUS EXPRESS(2) paclitaxel-eluting stent was evaluated on Major adverse cardiac events (cardiac death, MI, or target lesion revascularization) at 2 years (p=0.03). Everolimus-eluting stents reduced 2-year major adverse cardiac events compared to paclitaxel-eluting stents in patients with target lesions and jailed side branches (6.8% vs 19.0%; P=0.03).
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