Document Detail


Evaluation of the effects of everolimus-eluting and paclitaxel-eluting stents on target lesions with jailed side branches: 2-year results from the SPIRIT III randomized trial.
MedLine Citation:
PMID:  20506356     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate whether an everolimus-eluting stent (EES) with thinner stent struts and polymer results in less periprocedural myonecrosis and adverse outcomes.
BACKGROUND: Higher periprocedural myocardial infarction (MI) rates have been reported with the TAXUS® EXPRESS(2) paclitaxel-eluting stent (PES) compared to the bare metal EXPRESS(2)® stent due to more frequent side branch compromise, presumably attributable to the thickness of the stent/polymer on the PES.
METHODS: In the SPIRIT III trial, we identified 113 patients in the XIENCE V® EES group and 63 patients in the TAXUS EXPRESS(2) PES group who met the criteria of having a lesion with a jailed side branch (<2 mm diameter, and <50% stenosis). Two-year clinical outcomes were evaluated.
RESULTS: A periprocedural increase in Creatine Kinase-MB >1× upper normal level occurred in 9.0% of EES compared to 29.7% of PES patients with jailed side branches, P = 0.01. Through 2 years, major adverse cardiac events (MACE; cardiac death, MI, or target lesion revascularization [TLR]) occurred in 6.8% of EES and 19.0% of PES jailed side branch patients (P = 0.03), with numerically lower rates of MI (2.9% vs. 10.3%, P = 0.07) and TLR (3.9% vs. 10.3%, P = 0.17) in the EES group, with comparable rates of cardiac death (1.9% vs. 1.7%, P = 1.00).
CONCLUSIONS: In this post-hoc analysis of the SPIRIT III RCT, patients undergoing stenting of target lesions with jailed side branches with the thin strut and polymer XIENCE V EES compared to the thicker strut TAXUS PES had lower rates of MACE through 2 years due to fewer MIs and TLRs. © 2010 Wiley-Liss, Inc.
Authors:
Robert Applegate; James Hermiller; Jerome Williams; Paul Gordon; Julie Doostzadeh; Sherry Cao; Xiaolu Su; Krishnankutty Sudhir; Alexandra Lansky; Charles Simonton; Gregg Stone
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  76     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-26     Completed Date:  2011-02-09     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  644-51     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary / adverse effects,  instrumentation*,  mortality
Biological Markers / blood
Cardiovascular Agents / administration & dosage*
Coronary Angiography
Coronary Artery Disease / mortality,  radiography,  therapy*
Creatine Kinase, MB Form / blood
Drug-Eluting Stents*
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Infarction / blood,  etiology,  pathology,  prevention & control*
Myocardium / enzymology,  pathology
Necrosis
Paclitaxel / administration & dosage*
Prospective Studies
Prosthesis Design
Risk Assessment
Risk Factors
Severity of Illness Index
Single-Blind Method
Sirolimus / administration & dosage,  analogs & derivatives*
Time Factors
Treatment Outcome
United States
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Cardiovascular Agents; 159351-69-6/everolimus; 33069-62-4/Paclitaxel; EC 2.7.3.2/Creatine Kinase, MB Form; W36ZG6FT64/Sirolimus
Comments/Corrections
Comment In:
Catheter Cardiovasc Interv. 2010 Dec 1;76(7):1076-7; author reply 1078   [PMID:  21086494 ]
Catheter Cardiovasc Interv. 2010 Nov 1;76(5):652-3   [PMID:  20976746 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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