Sirolimus-eluting stent versus paclitaxel-eluting stent for patients with long coronary artery disease.
BACKGROUND
Outcomes remain relatively unfavorable for stent-based coronary intervention of lesions with long diseased segments. This study compared sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) for long coronary lesions.


RESULTS
The present randomized, multicenter, prospective study compared the use of long (> or =32 mm) SES with PES in 500 patients with long (> or =25 mm) native coronary lesions. The primary end point of the trial was the rate of binary in-segment restenosis according to follow-up angiography at 6 months. The SES and PES groups had similar baseline characteristics. Lesion length was 33.9+/-11.6 mm in the SES group and 34.5+/-12.6 mm in the PES group (P=0.527). The in-segment binary restenosis rate was significantly lower in the SES group than in the PES group (3.3% versus 14.6%; relative risk 0.23; P<0.001). In-stent late loss of lumen diameter was 0.09+/-0.37 mm in the SES group and 0.45+/-0.55 mm in the PES group (P<0.001). In patients with restenoses, a pattern of focal restenosis was more common in the SES group than in the PES group (100% versus 53.3%, P=0.031). Consequently, SES patients had a lower rate of target-lesion revascularization at 9 months (2.4% versus 7.2%, P=0.012). The incidence of death (0.8% in SES versus 0% in PES, P=0.499) or myocardial infarction (8.8% in SES versus 10.8% in PES, P=0.452) at 9 months of follow-up was not statistically different between the 2 groups.


CONCLUSIONS
For patients with long native coronary artery disease, SES implantation was associated with a reduced incidence of angiographic restenosis and a reduced need for target-lesion revascularization compared with PES implantation.
Kim
Young-Hak
YH
Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Park
Seong-Wook
SW
Lee
Seung-Whan
SW
Park
Duk-Woo
DW
Yun
Sung-Cheol
SC
Lee
Cheol Whan
CW
Hong
Myeong-Ki
MK
Kim
Hyun-Sook
HS
Ko
Jae-Ki
JK
Park
Jae-Hyeong
JH
Lee
Jae-Hwan
JH
Choi
Si Wan
SW
Seong
In-Whan
IW
Cho
Yoon Haeng
YH
Lee
Nae-Hee
NH
Kim
June Hong
JH
Chun
Kook-Jin
KJ
Park
Seung-Jung
SJ
D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D016503:Drug Delivery Systems; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D017239:Paclitaxel / Q000008:administration & dosage*; D019233:Retreatment; D020123:Sirolimus / Q000008:administration & dosage*; D016896:Treatment Outcome
D017239:Paclitaxel; D020123:Sirolimus