title: The unrestricted use of paclitaxel- versus sirolimus-eluting stents for coronary artery disease in an unselected population: one-year results of the Taxus-Stent Evaluated at Rotterdam Cardiology Hospital (T-SEARCH) registry.
abstract: OBJECTIVE
  We investigated the efficacy of paclitaxel-eluting stents (PES) compared to sirolimus-eluting stents (SES) when used without restriction in unselected patients.
  
  
  BACKGROUND
  Both SES and PES have been separately shown to be efficacious when compared to bare stents. In unselected patients, no direct comparison between the two devices has been performed.
  
  
  METHODS
  Paclitaxel-eluting stents have been used as the stent of choice for all percutaneous coronary interventions in the prospective Taxus-Stent Evaluated At Rotterdam Cardiology Hospital (T-SEARCH) registry. A total of 576 consecutive patients with de novo coronary artery disease exclusively treated with PES were compared with 508 patients treated with SES from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry.
  
  
  RESULTS
  The PES patients were more frequently male, more frequently treated for acute myocardial infarction, had longer total stent lengths, and more frequently received glycoprotein IIb/IIIa inhibitors. At one year, the raw cumulative incidence of major adverse cardiac events was 13.9% in the PES group and 10.5% in the SES group (unadjusted hazard ratio [HR] 1.33, 95% confidence interval [CI] 0.95 to 1.88, p = 0.1). Correction for differences in the two groups resulted in an adjusted HR of 1.16 (95% CI 0.81 to 1.64, p = 0.4, using significant univariate variables) and an adjusted HR of 1.20 (95% CI 0.85 to 1.70, p = 0.3, using independent predictors). The one-year cumulative incidence of clinically driven target vessel revascularization was 5.4% versus 3.7%, respectively (HR 1.38, 95% CI 0.79 to 2.43, p = 0.3).
  
  
  CONCLUSIONS
  The universal use of PES in an unrestricted setting is safe and is associated with a similar adjusted outcome compared to SES. The inferior trend in crude outcome seen in PES was due to its higher-risk population. A larger, randomized study enrolling an unselected population may assist in determining the relative superiority of either device.
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Dr. Molewaterplein 40, 3015-GD Rotterdam, the Netherlands.
authors.forename: Andrew T L
authors.initials: AT
authors.lastname: Ong
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Jiro
authors.initials: J
authors.lastname: Aoki
authors.forename: Angela
authors.initials: A
authors.lastname: Hoye
authors.forename: Carlos A G
authors.initials: CA
authors.lastname: van Mieghem
authors.forename: Gaston A
authors.initials: GA
authors.lastname: Rodriguez-Granillo
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Karel
authors.initials: K
authors.lastname: Sonnenschein
authors.forename: Evelyn
authors.initials: E
authors.lastname: Regar
authors.forename: Martin
authors.initials: M
authors.lastname: van der Ent
authors.forename: Peter P T
authors.initials: PP
authors.lastname: de Jaegere
authors.forename: Eugene P
authors.initials: EP
authors.lastname: McFadden
authors.forename: Georgios
authors.initials: G
authors.lastname: Sianos
authors.forename: Willem J
authors.initials: WJ
authors.lastname: van der Giessen
authors.forename: Pim J
authors.initials: PJ
authors.lastname: de Feyter
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D023903:Coronary Restenosis / Q000401:mortality; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017239:Paclitaxel / Q000008:administration & dosage; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents / Q000706:statistics & numerical data*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus