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Evaluation of the effects of everolimus-eluting and paclitaxel-eluting stents on target lesions with jailed side branches: 2-year results from the SPIRIT III randomized trial.

Author(s): Applegate R, Hermiller J, Williams J, Gordon P, Doostzadeh J, Cao S, Su X, Sudhir K, Lansky A, Simonton C, Stone G

Affiliation(s): Wake Forrest University School of Medicine, Winston-Salem, NC, USA. bapplega@wfubmc.edu

Publication date & source: 2010-11-01, Catheter Cardiovasc Interv., 76(5):644-51.

Publication type: Comparative Study; Multicenter Study; Randomized Controlled Trial

OBJECTIVE: To evaluate whether an everolimus-eluting stent (EES) with thinner stent struts and polymer results in less periprocedural myonecrosis and adverse outcomes. BACKGROUND: Higher periprocedural myocardial infarction (MI) rates have been reported with the TAXUS(R) EXPRESS(2) paclitaxel-eluting stent (PES) compared to the bare metal EXPRESS(2)(R) stent due to more frequent side branch compromise, presumably attributable to the thickness of the stent/polymer on the PES. Methods: In the SPIRIT III trial, we identified 113 patients in the XIENCE V(R) EES group and 63 patients in the TAXUS EXPRESS(2) PES group who met the criteria of having a lesion with a jailed side branch (<2 mm diameter, and <50% stenosis). Two-year clinical outcomes were evaluated. RESULTS: A periprocedural increase in Creatine Kinase-MB >1x upper normal level occurred in 9.0% of EES compared to 29.7% of PES patients with jailed side branches, P = 0.01. Through 2 years, major adverse cardiac events (MACE; cardiac death, MI, or target lesion revascularization [TLR]) occurred in 6.8% of EES and 19.0% of PES jailed side branch patients (P = 0.03), with numerically lower rates of MI (2.9% vs. 10.3%, P = 0.07) and TLR (3.9% vs. 10.3%, P = 0.17) in the EES group, with comparable rates of cardiac death (1.9% vs. 1.7%, P = 1.00). CONCLUSIONS: In this post-hoc analysis of the SPIRIT III RCT, patients undergoing stenting of target lesions with jailed side branches with the thin strut and polymer XIENCE V EES compared to the thicker strut TAXUS PES had lower rates of MACE through 2 years due to fewer MIs and TLRs. (c) 2010 Wiley-Liss, Inc.

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