Second-Generation DES Superior to First-Generation DES:<\/strong> The industry-funded SPIRIT IV investigators randomized 3687 patients to receive either an everolimus-eluting stent (EES) or a paclitaxel-eluting stent (PES). Unlike many previous DES trials, patients did not undergo routine follow-up angiography, thereby avoiding potential bias created by the “oculostenotic reflex.” At 1 year, the primary endpoint \u2014 target-lesion failure (defined as cardiac death, target-vessel MI, or ischemia-driven target-lesion revascularization) \u2014 was significantly lower in the EES arm compared to PES (4.2% vs. 6.8%, 95% CI 0.46-0.82, p=001). EES was broadly superior to PES in a number of secondary endpoints, according to the report in the New England Journal of Medicine<\/em><\/a>. In particular, the 1-year rates of MI and stent thrombosis were significantly lower in the EES group. The results of the trial also were consistent across a broad spectrum of subgroups, with the notable exception of diabetics, in whom no significant differences were observed.<\/p>\n In an accompanying editorial, Richard Lange and L. David Hillis<\/a> (who are also moderators of the Interventional Cardiology group on CardioExchange) ask: “Should we abandon paclitaxel-eluting stents in favor of second-generation everolimus-eluting stents” on the basis of SPIRIT IV? For diabetics, they write, first-generation DES may well suffice. “For patients without diabetes, an analysis of cost-effectiveness would help to determine whether the absolute reduction of 1 to 2 percentage points in myocardial infarction (mostly non\u2013ST-segment elevation) and the absolute reduction of 2 to 3 percentage points in target-lesion revascularization associated with the more costly everolimus-eluting stent (which is approximately $300 more expensive than the paclitaxel-eluting stent) warrant its routine use.”<\/p>\n 5-Year Outcomes for Left Main Stenting: <\/strong>The 5-year risk of death and the combined risk of death, Q-wave MI, or stroke were similar in patients with left main coronary disease who were treated with CABG or with a stent. In the <\/em>Journal of the American College of Cardiology<\/em><\/a>, Duk-Woo Park and colleagues from Korea report the 5-year results from the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) registry. (The 3-year results were previously published in the New England Journal of Medicine<\/em><\/a>.) However, the risk of target vessel revascularization was higher in the stenting group.<\/p>\n In a press statement issued by the European Society of Cardiology, William Wijns said: \u201cThis study should be added to the increasing hypothesis-generating signals emerging from various trials and registries that there may be a place for PCI in the treatment of selected patients with unprotected LMCA. The limitation of the study remains that it is a registry, possibly confounded by selection bias for either therapy. Ultimately only a prospective multi-center randomised trial will provide the definitive answer.”<\/p>\n","protected":false},"excerpt":{"rendered":" Second-Generation DES Superior to First-Generation DES: The industry-funded SPIRIT IV investigators randomized 3687 patients to receive either an everolimus-eluting stent (EES) or a paclitaxel-eluting stent (PES). Unlike many previous DES trials, patients did not undergo routine follow-up angiography, thereby avoiding potential bias created by the “oculostenotic reflex.” At 1 year, the primary endpoint \u2014 target-lesion failure (defined […]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-1521","post","type-post","status-publish","format-standard","hentry","category-general"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/1521","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=1521"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/1521\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=1521"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=1521"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=1521"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}