Drug-releasing stent shows promise for improving outcomes in patients with coronary artery disease

April 22, 2008

For patients who underwent angioplasty to open narrowed coronary arteries, the use of stents releasing the drug everolimus reduced the rate of renarrowing of the arteries and significantly reduced the risk of major cardiac events, compared to the widely-used paclitaxel-releasing stents, according to a study in the April 23/30 issue of JAMA.

Stents releasing the drugs paclitaxel and sirolimus have been shown to improve long-term event-free survival compared with bare-metal stents. However, restenosis (renarrowing of a coronary artery after angioplasty) still occurs, and the incidence of stent thrombosis (the formation or presence of a blood clot in a blood vessel), especially after the first year of implantation, is increased with these drug-releasing stents compared with their bare-metal counterparts, according to background information in the article.

Newer drug-releasing stents are being designed with the goal of enhanced safety, efficacy, or both. Everolimus-releasing stents have shown favorable results in preliminary studies in improving clinical and angiographic (radiographic visualization of the blood vessels) outcomes in patients with coronary artery disease.

Gregg W. Stone, M.D., of Columbia University Medical Center and the Cardiovascular Research Foundation, New York, and colleagues conducted the SPIRIT III trial to evaluate the everolimus-releasing stent in comparison to the paclitaxel-releasing stent in 1,002 patients with coronary artery disease. Patients were randomized 2:1 to receive the everolimus-releasing stent (n = 669) or the paclitaxel-releasing stent (n = 333). Angiographic follow-up was prespecified at 8 months in 564 patients and completed in 436 patients. Clinical follow-up was performed at 1, 6, 9, and 12 months.

The researchers found that angiographic in-segment late loss (a measure of restenosis) was significantly less in the everolimus-releasing stent group compared with the paclitaxel group. At 9 months, everolimus stents, compared with paclitaxel stents, were noninferior for the outcome of target vessel failure (47 of 657 patients [7.2 percent] vs. 29 of 321 [9.0 percent], respectively. Use of the everolimus stent compared with the paclitaxel stent resulted in a 44 percent reduction (4.6 percent vs. 8.1 percent) at 9 months in the composite of major adverse cardiac events (cardiac death, heart attack, or target vessel revascularization [repeat procedure to unblock a blood vessel]), and a 42 percent reduction in the composite of major adverse cardiac events at 1 year (6.0 percent vs. 10.3 percent). This was due to fewer heart attacks and target lesion revascularization procedures.

“This large-scale, prospective, randomized, single-blind, controlled study demonstrates that an everolimus-eluting stent compared with a widely used paclitaxel-eluting stent results in a significant reduction in angiographic in-segment late loss at 8 months, with noninferior 9-month rates of ischemia-driven target vessel failure,” the authors write.

Citation: JAMA. 2008;299[16]:1903-1913.

Source: JAMA and Archives Journals

Explore further: Percutaneous coronary intervention is a well-justified option in severe coronary artery disease

Related Stories

Percutaneous coronary intervention is a well-justified option in severe coronary artery disease

December 12, 2017
The treatment of left main coronary artery disease by percutaneous coronary intervention is associated with a smaller risk of severe cardiovascular events than coronary artery bypass grafting in the weeks following surgery. ...

New drug-eluting stents very promising

December 5, 2017
New-generation stents containing anti-vasoconstriction medication perform well. They are safe and efficient for most patients, over both the short term and the long term. According to Liefke van der Heijden, a trainee cardiologist ...

For infants with heart disease, are shunts or stents better to maintain blood flow?

November 21, 2017
Infants with various forms of congenital heart disease require a stable source of blood flow to their lungs in order to survive until a more definitive operation can be performed. In a recent study, pediatric researchers ...

Odds for carotid artery stenting in seniors up post-CREST era

December 4, 2017
(HealthDay)—The odds of carotid artery stenting (CAS) have increased in the post-Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) era, despite safety concerns for patients older than 70 years, according ...

Mobile stroke units designed to quickly reach, treat patients

November 28, 2017
"Time is brain." That's the mantra of physicians who warn that those with stroke symptoms need immediate medical attention.

Stroke patients may have more time to get treatment, study finds

November 22, 2017
Patients and doctors long have relied on a simple rule of thumb for seeking care after an ischemic stroke: "Time is brain."

Recommended for you

New cellular approach found to control progression of chronic kidney disease

December 15, 2017
Researchers have demonstrated for the first time that extracellular vesicles - tiny protein-filled structures - isolated from amniotic fluid stem cells (AFSCs) can be used to effectively slow the progression of kidney damage ...

Testing shows differences in efficacy of Zika vaccines after one year

December 15, 2017
(Medical Xpress)—A large team of researchers with members from Harvard Medical School, Walter Reed Army Institute of Research, Bioqual Inc. and MIT has found that the efficacy of the three types of Zika vaccines currently ...

How to regulate fecal microbiota transplants

December 15, 2017
(Medical Xpress)—A small team of researchers at the University of Maryland, some with affiliations to the Veterans Affairs Maryland Health Care System, has written and published a Policy Forum piece in the journal Science ...

Screening could catch a quarter of hip fractures before they happen

December 15, 2017
Community screening for osteoporosis could prevent more than a quarter of hip fractures in older women - according to new research led by the University of East Anglia (UEA).

Urine test developed to test for tuberculosis

December 14, 2017
(Medical Xpress)—An international team of researchers has developed a urine test that can be used to detect tuberculosis (TB) in human patients. In their paper published in Science Translational Medicine, the group describes ...

40 years after first Ebola outbreak, survivors show signs they can stave off new infection

December 14, 2017
Survivors of the first known Ebola outbreak, which occurred in the Democratic Republic of the Congo in 1976, may be key to development of vaccines and therapeutic drugs to treat future outbreaks, according to a new study ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.