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Improved efficacy observed with newer- vs. older-generation ZES
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The antirestenotic efficacy of a newer-generation zotarolimus-eluting stent was superior to an earlier iteration and similar to other limus-eluting stents in a recent meta-analysis.
Researchers reviewed 12 randomized controlled trials of 13,709 patients with significant chronic stable or unstable CAD who were randomly assigned to PCI with the Resolute zotarolimus-eluting stent (R-ZES; Medtronic) vs. other limus-eluting stents (LES) or with the Endeavor zotarolimus-eluting stent (E-ZES; Medtronic) vs. LES.
There was no difference between R-ZES and LES for the risk of ischemia-driven target vessel revascularization (ID-TVR), MI, cardiac death and stent thrombosis. The risk was similar between E-ZES and LES for MI, cardiac death and stent thrombosis, the study found.
Patients receiving E-ZES were more likely to experience ID-TVR than those receiving LES (OR=1.95; 95% CI, 1.40-2.73). An indirect comparison showed that PCI with R-ZES compared with E-ZES reduced the risk for ID-TVR (OR=0.54; 95% CI, 0.37-0.78), without increasing MI (OR=1.09; 95% CI, 0.62-1.93), cardiac death (OR=0.97; 95% CI, 0.46-2.00) or stent thrombosis (OR=1.07; 95% CI, 0.40-2.80).
Investigators noted four main points: R-ZES has similar antirestenotic efficacy and thrombogenicity as other LES; E-ZES has inferior antirestenotic efficacy but similar thrombogenicity as other LES; R-ZES exceeds the antirestenotic efficacy of E-ZES; and the higher antirestenotic efficacy of R-ZES vs. E-ZES is not diminished by its higher thrombogenicity.
“We demonstrated that the new polymer coating of R-ZES, the sole difference with the preceding platforms, plays a pivotal role with respect to the clinical efficacy as compared with LES, and that it likely represents a significant step forward as compared with E-ZES,” the researchers wrote.
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