The paclitaxel-eluting stent in percutaneous coronary intervention: Part II. Comparison with the sirolimus-eluting stent, economics, and unanswered questions.
The paclitaxel- and sirolimus-eluting stents are currently the only drug-eluting stents approved for use in the United States. These 2 stents differ in terms of mechanism of drug action, the construct of the stent itself, and the drug delivery polymer. Clinical trials have demonstrated superiority of both paclitaxel- and sirolimus-eluting stents when compared with bare-metal stents in terms of reducing restenosis and the need for target vessel revascularization. Recently published head-to-head trials have not conclusively shown 1 drug-eluting stent to be superior to the other, but have demonstrated more favorable angiographic results with the sirolimus-eluting stent compared with the paclitaxel-eluting stent; however, no significant difference has been demonstrated in clinical outcomes such as myocardial infarction or death. In terms of economics, the paclitaxel-eluting stent is substantially more expensive than the bare-metal stent. However, by significantly reducing the risk of restenosis and need for repeat revascularization, the higher direct cost of the paclitaxel-eluting stent may in theory be offset by lower overall healthcare costs, although economic analyses have yet to definitively establish that the paclitaxel-eluting stent is truly cost-effective. There is still much to be discovered regarding the paclitaxel-eluting stent, specifically the optimal stent design and drug release mechanism, the relative safety and efficacy of the paclitaxel-eluting stent compared with other drug-eluting stents, the long-term effects of the paclitaxel-eluting stent, the ideal antiplatelet regimen to use in patients with a paclitaxel-eluting stent, the safety and efficacy of the paclitaxel-eluting stent in various high-risk patient groups, and the ultimate cost-effectiveness of this device.
Ray
Gretchen M
GM
University of New Mexico College of Pharmacy, Albuquerque, New Mexico 87131-0001, USA.
Nawarskas
James J
JJ
Frishman
William H
WH
D015906:Angioplasty, Balloon, Coronary / Q000191:economics; D019917:Blood Vessel Prosthesis Implantation / Q000191:economics; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use; D023921:Coronary Stenosis / Q000191:economics / Q000628:therapy; D003362:Cost-Benefit Analysis; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D017239:Paclitaxel / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D011474:Prosthesis Design / Q000191:economics; D016032:Randomized Controlled Trials as Topic; D020123:Sirolimus / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D015607:Stents / Q000191:economics
D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus