Key result
Sirolimus-eluting stents had similar major adverse cardiac events compared to paclitaxel-eluting stents (6.4% vs 11.2%, P=0.184) but lower in-stent restenosis (0% vs 15.5%, P=0.001).
Why the study?
Does sirolimus-eluting stent compared to paclitaxel-eluting stent reduce major adverse cardiac events and restenosis in patients with de-novo ostial coronary lesions?
Cohort (n=95)
Does sirolimus-eluting stent compared to paclitaxel-eluting stent reduce major adverse cardiac events and restenosis in patients with de-novo ostial coronary lesions?
Sirolimus-eluting stents may offer superior angiographic outcomes regarding restenosis and late loss compared to paclitaxel-eluting stents in de-novo ostial coronary lesions, despite similar clinical MACE rates at 8 months.
Answers are grounded in this paper and cite their sources.
May favor sirolimus-eluting stents for ostial lesions on angiography; leaves open clinical benefit and requires randomized confirmation.
BACKGROUND: Treatment of ostial coronary lesions represents a challenge for interventional cardiologists. The efficacy of drug-eluting stents (DES) has been demonstrated as improving the outcomes of patients in a few studies. It is not known, however, which DES, sirolimus-eluting stent (SES) versus paclitaxel-eluting stent (PES), is superior for the treatment of ostial lesions. METHODS: In this retrospective study, 95 consecutive patients with de-novo ostial lesions underwent coronary SES (n=47, lesions=48) or PES implantation (n=45, lesions=47), and quantitative coronary analysis was performed at the time of stent implantation and subsequently at 8 months post stenting. Ostial lesion was defined as > or =50% diameter stenosis rising within 3 mm of either left anterior descending coronary artery or left circumflex artery or right coronary artery measured by quantitative coronary analysis. Major adverse cardiac events including death, thrombosis, nonfatal myocardial infarction, and target lesion revascularization were compared between the two groups. RESULTS: Baseline clinical and angiographic characteristics were well balanced between the two groups. At 8 months clinical and angiographic follow-up, overall major adverse cardiac events and target lesion revascularization rates were similar in both groups (6.4 vs. 11.2%, P=0.184; 4.3 vs. 8.9%, P=0.170, respectively). The in-stent and in-segment restenosis were, however, significantly higher in PES group compared with SES group (15.5 vs. 0%, P=0.001; 22.2 vs. 4.3%, P=0.003). Similarly, the late loss in both in-stent and in-segment was significantly higher in the PES group than in SES group (0.65+ or -0.67 vs. 0.16+ or -0.18 mm; 0.68+ or -0.65 vs. 0.15+ or -0.12 mm; P<0.001, respectively). CONCLUSION: In this small sample-size, nonrandomized, and nonprospective study, the data indicated that implantation of DES appears safe and effective for the treatment of patients with de-novo ostial coronary lesions, but SES implantation showed more favorable results in respect of restenosis compared with PES implantation.
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Chen et al. (2008) conducted a cohort in de-novo ostial coronary lesions (n=95). Sirolimus-eluting stent vs. Paclitaxel-eluting stent was evaluated on Major adverse cardiac events including death, thrombosis, nonfatal myocardial infarction, and target lesion revascularization (p=0.184). Sirolimus-eluting stents had similar major adverse cardiac events compared to paclitaxel-eluting stents (6.4% vs 11.2%, P=0.184) but lower in-stent restenosis (0% vs 15.5%, P=0.001).
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