Comparison of the effectiveness of sirolimus- and paclitaxel-eluting stents for small coronary artery lesions
Kyoung-Ha Park MD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorSeong-Wook Park MD, PhD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorMyeong-Ki Hong MD, PhD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorYoung-Hak Kim MD, PhD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorBong-Ki Lee MD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorDuk-Woo Park MD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorBong-Ryong Choi MD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorMi-Jeong Kim MD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorKyoung-Min Park MD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorCheol Whan Lee MD, PhD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Gang Neung, Korea
Search for more papers by this authorSang-Sig Cheong MD, PhD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Gang Neung, Korea
Search for more papers by this authorJae-Joong Kim MD, PhD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorCorresponding Author
Seung-Jung Park MD, PhD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, KoreaSearch for more papers by this authorKyoung-Ha Park MD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorSeong-Wook Park MD, PhD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorMyeong-Ki Hong MD, PhD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorYoung-Hak Kim MD, PhD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorBong-Ki Lee MD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorDuk-Woo Park MD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorBong-Ryong Choi MD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorMi-Jeong Kim MD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorKyoung-Min Park MD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorCheol Whan Lee MD, PhD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Gang Neung, Korea
Search for more papers by this authorSang-Sig Cheong MD, PhD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Gang Neung, Korea
Search for more papers by this authorJae-Joong Kim MD, PhD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Search for more papers by this authorCorresponding Author
Seung-Jung Park MD, PhD
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, KoreaSearch for more papers by this authorAbstract
Background: The sirolimus-eluting stent (SES) and the paclitaxel-eluting stent (PES) reduce restenosis in small coronary artery lesions. However, it is not clear which of these stents is superior in terms of clinical outcomes. Methods: The authors retrospectively examined 197 patients with 245 de novo small coronary artery lesions (≤≤2.75 mm) that were treated with either the SES (156 lesions) or the PES (89 lesions). Six-month angiographic restenosis rates and the 9-month target lesion revascularization (TLR) rates were compared between the two groups. Results: In terms of baseline clinical and angiographic parameters, the two groups well matched together. Six-month angiographic follow-up was performed on 170 patients (86.3%), comprising 135 SES lesions (86.5%) and 76 PES lesions (85.4%). At 6-month angiographic follow-up, the late lumen loss was less in the SES group than in the PES group (0.29 ± 0.42 vs. 0.69 ± 0.63 mm, P < 0.01). Therefore, the SES group showed a lower rate of angiographic restenosis than the PES group (6.7% vs. 27.7%, P < 0.01). At 9 months there were no deaths or myocardial infarctions in either group. The 9-month TLR rate was lower in the SES group than in the PES group (3.3% vs. 14.4%, P < 0.01). The Kaplan-Meier estimate of freedom from TLR at 9 months was 96.7% for the SES patients and 86.5% for the PES patients (P < 0.01). Conclusions: The SES treatment may be superior to the PES treatment in terms of long-term clinical and angiographic outcomes in patients with small coronary artery lesions. © 2006 Wiley-Liss, Inc.
REFERENCES
- 1 Elezi S, Kastrati A, Neumann FJ, Hadamitzky M, Dirschinger J, Schomig A. Vessel size and long-term outcome after coronary stent placement. Circulation 1988; 98: 1875–1880.
- 2 Bauters C, Hubert E, Part A, Bougrimi K, Van Belle E, McFadden EP, Amouyel P, Lablanche JM, Bertrand M. Predictors of restenosis after coronary artery stent implantation. J Am Coll Cardiol 1998; 31: 1291–1298.
- 3 Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O'Shaughnessy C, Caputo RP, Kereiakes DJ, Williams DO, Teirstein PS, et al., for SIRIUS Investigators. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 2003; 349: 1315–1323.
- 4 Grube E, Silber S, Hauptmann KE, Mueller R, Buellesfeld L, Gerckens U, Russell ME. TAXUS I: 6- and 12-month results from randomized, double-blind trial on a slow-release paclitaxel-eluting stent for de novo coronary lesions. Circulation 2003; 107: 38–42.
- 5 Schofer J, Schluter M, Gershlick AH, Wijns W, Garcia E, Schampaert E, Breithardt G, for E-SIRIUS Investigators. Sirolimus-eluting stents for treatment of patients with long atherosclerotic lesions in small coronary arteries: Double-blind, randomized controlled trial (E-SIRIUS). Lancet 2003; 362: 1093–1099.
- 6 Schampaert E, Cohen EA, Schluter M, Reeves F, Traboulsi M, Title LM, Kuntz RE, Popma JJ, for C-SIRIUS Investigators. The Canadian study of the sirolimus-eluting stent in the treatment of patients with long de novo lesions in small native coronary arteries (C-SIRIUS). J Am Coll Cardiol 2004; 43: 1110–1115.
- 7 Stone GW, Ellis SG, Cox DA, Hermiller J, O'Shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, et al., for TAXUS-IV Investigators. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 2004; 350: 221–230.
- 8 Sheehan FH, Braunwald E, Canner P, Dodge HT, Gore J, Van Natta P, Passamani ER, Williams DO, Zaret B. The effect of intravenous thrombolytic therapy on left ventricular function: A report on the tissue-type plasminogen activator and streptokinase from the thrombolysis in myocardial infarction (TIMI) phase 1 trial. Circulation 1987; 75: 817–829.
- 9 Mehran R, Dangas G, Abizaid AS, Mintz GS, Lansky AJ, Satler LF, Pichard AD, Kent KM, Stone GW, Leon MB. Angiographic patterns of in-stent restenosis: Classification and implications for long-term outcome. Circulation 1999; 100: 1872–1878.
- 10 Park SW, Lee CW, Hong MK, Kim JJ, Cho GY, Nah DY, Park SJ. Randomized comparison of coronary stenting with optimal balloon angioplasty for treatment lesions in small coronary arteries. Eur Heart J 2000; 21: 1785–1789.
- 11 Doucet S, Schalij MJ, Vrolix MC, Hilton D, Chenu P, de Bruyne B, Udayachalerm W, Seth A, Bilodeau L, Reiber JH, et al., for Stent In Small Arteries(SISA) Trial Investigators. Stent placement to prevent restenosis after angioplasty in small coronary arteries. Circulation 2001; 104: 2029–2033.
- 12 Haude M, Konorza TF, Kalnins U, Erglis A, Saunamaki K, Glogar HD, Grube E, Gil R, Serra A, Richardt HG, et al., for Heparin-COAted STents in small coronary arteries Trial Investigators. Heparin-coated stent placement for the treatment of stenosis in small coronary arteries of symptomatic patients. Circulation 2003; 107: 1265–1270.
- 13 Holmes DR, Kereiakes DJ. The approach to small vessels in the era of drug-eluting stents. Rev Cardiovasc Med 2005; 6: S31–S37.
- 14 Windecker S, Remondino A, Eberli FR, Juni P, Raber L, Wenaweser P, Togni M, Billinger M, Tuller D, Seiler C, et al. Sirolimus-eluting and paclitaxel-eluting stents for coronary revascularization. N Engl J Med 2005; 353: 653–662.
- 15 Dibra A, Kastrati A, Mehilli J, Pache J, Schuhlen H, von Beckerath N, Ulm K, Wessely R, Dirschinger J, Schomig A, for ISAR-DIABETES Study Investigators. Paclitaxel-eluting or sirolimus-eluting stents to prevent restenosis in diabetic patients. N Engl J Med 2005; 353: 663–670.
- 16 Briguori C, Sarais C, Pagnotta P, Liistro F, Montorfano M, Chieffo A, Sgura F, Corvaja N, Albiero R, Stankovic G, et al. In-stent restenosis in small coronary arteries. Impact of strut thickness. J Am Coll Cardiol 2002; 40: 403–409.
- 17 Hoffmann R, Radke PW, Ortlepp JR, Haager PK, Blindt R, Iofina E, Franke A, Langenberg R, Weber C, Hanrath P. Intravascular ultrasonic comparative analysis of degree of intimal hyperplasia produced by four different stents in the coronary arteries. Am J Cardiol 2004; 94: 1548–1550.
- 18 Mauri L, Orav EJ, O'Malley AJ, Moses JW, Leon MB, Holmes DR,Jr, Teirstein PS, Schofer J, Breithardt G, Cutlip DE, et al. Relationship of late loss in lumen diameter to coronary restenosis in sirolimus-eluting stents. Circulation 2005; 111: 321–327.
- 19 Kastrati A, Dibra A, Eberle S, Mehilli J, Suarez de Lezo J, Goy JJ, Ulm K, Schomig A. Sirolimus-eluting stents vs paclitaxel-eluting stents in patients with coronary artery disease: Meta-analysis of randomized trials. JAMA 2005; 294: 819–825.
- 20 Saucedo JF, Mehran R, Dangas G, Hong MK, Lansky A, Kent KM, Satler LF, Pichard AD, Stone GW, Leon MB. Long-term clinical events following creatine kinase–myocardial band isoenzyme elevation after successful coronary stenting. J Am Coll Cardiol 2000; 35: 1134–1141.
