Everolimus-eluting stents compared with paclitaxel-eluting stents for treatment of coronary in-stent restenoses

Abstract

Everolimus-eluting stent (EES) implantation was superior to paclitaxel-eluting stent (PES) implantation for treatment of de-novo coronary artery disease. We evaluated the outcome of EES compared with PES for treatment of restenosis in bare-metal and drug-eluting stents (DES). In a prospective observational study patients with in-stent restenosis (ISR) were treated with EES (N=91) or PES (N=107). Dual antiplatelet therapy was given for 6 months. Patients were scheduled for 6 months angiographic follow-up and 24 months clinical follow-up. Primary outcome measure was the occurrence of major adverse cardiac events (MACE) defined as a composite of cardiac death, any myocardial infarction and target lesion revascularization (TLR). Baseline data showed some differences between groups including frequency of DES restenosis, length of stented segment and reference vessel diameter. For EES versus PES occurrence of MACE (18.7% vs. 15.0%, p=0.48) and need for TLR did not differ (13.2% vs. 9.3%, p=0.39). In-stent late loss was similar with 0.20±0.39 mm for EES and 0.18±0.31mm for PES (p=0.34). Binary angiographic restenosis rate for the total segment was 18.0% and 16.7% (p=0.85), respectively. In multivariable analysis the stented length (p=0.014), minimal lumen diameter post stenting (p<0.01) and repeated restenosis (p<0.001) were risk factors for a higher late loss but not type of DES or presence of diabetes mellitus. In this observational registry treatment of DES and BMS restenosis with EES versus PES implantation resulted in similar clinical and angiographic outcome.