Key result
Everolimus-eluting stents significantly reduced 1-year target lesion failure compared to paclitaxel-eluting stents in both elderly (3.9% vs 6.8%, P=0.006) and younger patients (4.9% vs 7.9%, P=0.003).
Why the study?
Does everolimus-eluting stent implantation reduce target lesion failure and MACE compared to paclitaxel-eluting stent implantation in both younger and older patients?
Meta-Analysis (n=4,689)
Yes
Does everolimus-eluting stent implantation reduce target lesion failure and MACE compared to paclitaxel-eluting stent implantation in both younger and older patients?
Absolute Event Rate: 3.9% vs 6.8%
p-value: p=0.006
Everolimus-eluting stents are safer and more effective than paclitaxel-eluting stents at one year, regardless of patient age.
Favors everolimus-eluting over paclitaxel-eluting stents regardless of age; reinforces Level 1 evidence for drug-eluting stent selection.
AIMS: The impact of age on outcomes following everolimus-eluting stent (EES) or paclitaxel-eluting stent (PES) implantation was evaluated in a patient-level pooled analysis of the SPIRIT III (n=1,002) and SPIRIT IV (n=3,687) trials. METHODS AND RESULTS: Clinical outcomes with EES compared to PES in elderly (≥ 65 years, n=2,071) and younger (<65 years, n=2,617) patients were evaluated at one year. At one year, elderly patients treated with EES rather than PES showed a significant reduction in target lesion failure (TLF) (3.9% EES vs. 6.8% PES, p=0.006), major adverse cardiac events (MACE) (4.0% EES vs. 7.1% PES, p=0.005), and ischaemia-driven target lesion revascularisation (ID-TLR) (2.0% EES vs. 4.0% PES, p=0.01). Younger patients treated with EES rather than PES also had significantly reduced one-year rates of TLF (4.9% EES vs. 7.9% PES, p=0.003), MACE (5.0% EES vs. 8.0% PES, p=0.004), target vessel myocardial infarction (MI) (2.0% EES vs. 3.4% PES, p=0.04), ID-TLR (3.3% EES vs. 5.5% PES, p=0.01) and stent thrombosis (0.5% EES vs. 1.6% PES, p=0.01). CONCLUSIONS: In a pooled analysis from the SPIRIT III and IV trials, EES was safer and more effective than PES in both younger and older cohorts as evidenced by lower rates of TLR, TLF and MACE.
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Hermiller et al. (2012) conducted a meta-analysis in Coronary artery disease requiring stent implantation (n=4,689). Everolimus-eluting stent (EES) vs. Paclitaxel-eluting stent (PES) was evaluated on Target lesion failure (TLF) at one year in elderly patients (≥ 65 years) (p=0.006). Everolimus-eluting stents significantly reduced 1-year target lesion failure compared to paclitaxel-eluting stents in both elderly (3.9% vs 6.8%, P=0.006) and younger patients (4.9% vs 7.9%, P=0.003).
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