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Everolimus-Eluting Stent Better Than Paclitaxel-Eluting Stent in Unselected Patients NEW YORK -- January 7, 2010 -- The everolimus-eluting stent is better than the second generation paclitaxel-eluting stent in unselected patients undergoing percutaneous coronary intervention (PCI) in terms of safety and efficacy, according to a study published online first and appearing in an upcoming edition of the The Lancet. On the basis of these findings, Pieter Cornelis Smits, MD, Elvin Kedhi, MD, and Eugene McFadden, MD, Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands, and colleagues suggest that paclitaxel-eluting stents should no longer be used in everyday clinical practice. Compared with the currently available first-generation drug-eluting stents, second-generation drug-eluting stents have been designed with the goal of improving safety, efficacy, and device performance. A significant reduction in serious adverse cardiac events was noted in patients with the everolimus-eluting stent compared with those who had the first-generation paclitaxel-eluting stent. This first-generation stent has been superseded in Europe by the new-generation paclitaxel-eluting stent since September, 2005. Whether such differences persist with a new-generation paclitaxel-eluting stent that consists of the same polymer but has a different stent platform is not known. The Comparison of Everolimus-Eluting and Paclitaxel-Eluting Stents (COMPARE) study randomly assigned 1,800 consecutive patients (aged 18-85 years) undergoing PCI at 1 centre to treatment with everolimus-eluting and second-generation paclitaxel-eluting stents. The primary endpoint was a composite of safety and efficacy (all-cause mortality, myocardial infarction, and target vessel revascularisation) within 12 months. Follow-up was completed in 1,797 patients. The primary endpoint occurred in 56 (6%) patients in the everolimus-eluting stent group versus 82 (9%) in the paclitaxel-eluting stent group (relative risk of primary endpoint occurring was 31% lower for the everolimus group). The difference was attributable to a lower rate of stent thrombosis (6 vs 23), MI (25 vs 48), and target vessel revascularisation (21 vs 54). Cardiac death, non-fatal MI or target-lesion revascularisation occurred in 44 patients in the everolimus-stent group versus 74 patients in the paclitaxel-stent group. “The use of second-generation everolimus-eluting stents, compared with paclitaxel-eluting stents, was associated with a significant reduction in the risk of major adverse cardiac events at 1 year,” the authors wrote. “This difference was a result of reduction in the rate of myocardial infarction, a safety component of the primary endpoint, and reduction in repeat revascularisation of the target vessel.” “The everolimus-eluting stent is better than the second generation paclitaxel-eluting stent in unselected patients in terms of safety and efficacy,” they concluded. “On the basis of our results, we suggest that paclitaxel-eluting stents should no longer be used in everyday clinical practice.” SOURCE: The Lancet E-mail this page to a friend or colleague! To print, use this version