New Study Suggests Older Stent Better Than New

A head-to-head comparison of drug-coated stents suggests the old standby that used the drug sirolimus prevents more major cardiac events than a newer version, which is coated with zotarolimus. Coating stents with time-released drugs can help prevent infection or clogging, but it’s not clear whether there’s a clinical effect seen with the different coatings.

“This study adds to the evidence base,” says Alice K. Jacobs, MD, national spokeswoman and past president of the American Heart Association and director of the cardiac catheterization laboratories and of interventional cardiology at Boston Medical Center.

But she says it’s only one study. “Medical directors will need to critically review the data from multiple trials before deciding which stents to use in a given subset of patients.”

Researchers at Ulsan College of Medicine in South Korea compared zotarolimus-eluting stents (ZES) with the widely used sirolimus- and paclitaxel-eluting stents (SES, PES) in routine clinical practice and randomly assigned 2,645 patients who were set to undergo angioplasty to receive one of the three types of stents.

The primary endpoint in the trial was a composite of major adverse cardiac events (MACE) and included death, myocardial infarction, and ischemia-driven revascularization after 12 months of therapy.

Noninferiority comparisons (between ZES vs. SES) and superiority comparisons (between ZES vs. PES) were performed. Their findings, published in the Journal of the American College of Cardiology, suggest the patients in the ZES group had noninferior rates of MACE than the SES group (10.2 percent vs. 8.3 percent) and significantly fewer MACE than the PES group (10.2 percent vs. 14.1 percent). The incidence of death or myocardial infarction was similar among the groups, but the incidence of stent thrombosis was significantly lower in the SES group.

Less stent thrombosis is likely to mean fewer revascularizations. “A decrease in repeat procedures will likely be associated with a decrease in costs,” says Jacobs.

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