Sirolimus-eluting stents were superior to paclitaxel-eluting stents for coronary bifurcation lesions

Patients with coronary bifurcation lesions who had a sirolimus-eluting stent implanted had better long-term outcomes compared with those who had paclitaxel-eluting stents implanted, data from the COBIS trial indicated.

Korean researchers compared major adverse cardiac events among 1,595 patients from the COBIS registry, a retrospective registry of patients from 16 centers who underwent percutaneous coronary intervention for bifurcation lesions with drug-eluting stents between January 2004 and June 2006. They evaluated 1,033 patients treated with sirolimus-eluting stents (SES) and 562 who had paclitaxel-eluting stents (PES) implanted, with median follow-up conducted at 22 months.

The researchers found that SES implantation was associated with a lower overall incidence of major adverse cardiac events (HR=0.53; 95% CI, 0.32-0.89) and target lesion revascularization (HR=0.55; 95% CI, 0.31-0.97) but not with cardiac death (HR=2.77; 95% CI, 0.40-18.99) and cardiac death or MI (HR=0.97; 95% CI, 0.38-2.49).

Lower rates of major adverse cardiac events and target lesion revascularization in patients assigned to SES remained after the researchers evaluated 407 patient pairs matched by propensity score. There were no significant differences in stent thrombosis rates between the two groups (0.7% vs. 0.7%).

“In this study, we demonstrated that SES was more effective in improving long-term outcomes than was PES, primarily by decreasing repeat revascularization,” the researchers wrote. – by Nicole Blazek

Song YB. J Am Coll Cardiol. 2010;doi:10.1016/j.jacc.2010.02.008.

Though not from a randomized trial, the results were consistent with a number from other studies that suggest that first- generation PES are inferior to other DES.

– Deepak L. Bhatt, MD, MPH
Cardiology Today Editorial Board

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