Everolimus-Eluting versus Paclitaxel-Eluting Stents in Coronary Artery Disease

Gregg W. Stone, Ali Rizvi, William Newman, Kourosh Mastali, John C. Wang, Ronald Caputo, Julie Doostzadeh, Sherry Cao, Charles A. Simonton, Krishnankutty Sudhir, Alexandra J. Lansky, Donald E. Cutlip, Dean J. Kereiakes

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789 Scopus citations

Abstract

Background: Previous studies have established the superiority of coronary everolimus-eluting stents over paclitaxel-eluting stents with respect to angiographic findings. However, these trials were not powered for superiority in clinical end points. Methods: We randomly assigned 3687 patients at 66 U.S. sites to receive everolimus-eluting stents or paclitaxel-eluting stents without routine follow-up angiography. The primary end point was the 1-year composite rate of target-lesion failure (defined as cardiac death, target-vessel myocardial infarction, or ischemia-driven target-lesion revascularization). Results: Everolimus-eluting stents were superior to paclitaxel-eluting stents with respect to the primary end point of target-lesion failure (4.2% vs. 6.8%; relative risk, 0.62; 95% confidence interval, 0.46 to 0.82; P = 0.001). Everolimus-eluting stents were also superior with respect to the major secondary end point of the 1-year rate of ischemia-driven target-lesion revascularization (P = 0.001) and were noninferior with respect to the major secondary end point of the 1-year composite rate of cardiac death or target-vessel myocardial infarction (P<0.001 for noninferiority; P = 0.09 for superiority). The 1-year rates of myocardial infarction and stent thrombosis were also lower with everolimus-eluting stents than with paclitaxel-eluting stents (1.9% vs. 3.1%, P = 0.02 for myocardial infarction; 0.17% vs. 0.85%, P = 0.004 for stent thrombosis). Target-lesion failure was consistently reduced with everolimus-eluting stents as compared with paclitaxel-eluting stents in 12 prespecified subgroups, except in the subgroup of patients with diabetes (6.4% vs. 6.9%, P = 0.80). Conclusions: Everolimus-eluting stents, as compared with paclitaxel-eluting stents, resulted in reduced rates of target-lesion failure at 1 year, results that were consistent in all patients except those with diabetes, in whom the results were nonsignificantly different. (ClinicalTrials.gov number, NCT00307047.)

Original languageEnglish
Pages (from-to)1663-1674
Number of pages12
JournalNew England Journal of Medicine
Volume362
Issue number18
DOIs
StatePublished - 6 May 2010
Externally publishedYes

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