Sirolimus-Eluting Stent Versus Paclitaxel-Eluting Stent for Patients With Long Coronary Artery Disease

Kim, Young Hak; Park, Seong Wook; Lee, Seung Whan; Park, Duk‐Woo; Yun, Sung Cheol; Lee, Cheol Whan; Hong, Myeong Ki; Kim, Hyun Sook; Ko, Jung Ho; Park, Jae‐Hyeong; Lee, Jae‐Hwan; Choi, Si Wan; Seong, In Whan; Cho, Yoon Haeng; Lee, Nae Hee; Kim, June Hong; Chun, Kook Jin

doi:10.1161/circulationaha.106.666396

Cited by 108 publications

(65 citation statements)

References 33 publications

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“…That study also showed that the two stents did not differ in terms of the target lesion revascularization rates(6.4% vs. 12.2%, respectively, p=0.13). We recently reported the results of the Long-DES II trial, 25) which compared the use of Cypher and Taxus stents in 500 patients with long(≥25 mm) native coronary lesions. The study found that the Cypher stent was associated with a lower in-segment binary restenosis rate than the Taxus stent(3.3% versus 14.6%, respectively, relative risk : 0.23, p<0.001).…”

Section: Stent-related Factorsmentioning

confidence: 99%

Predictive Factors for Restenosis after Drug-Eluting Stent Implantation

Lee

Park

2007

Korean Circ J

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Background and Objectives：Despite the dramatic reduction in restenosis conferred by drug-eluting stents (DES), restenosis remains a significant problem for real-world patients. Restenosis is a complex phenomenon, and a variety of stent-, drug-, patient-and lesion-related factors have been studied as the determinants of restenosis after DES implantation. Methods and Results：The stent delivery system, the polymer and the drug are integral components of DES, and these are the device-specific factors that can affect restenosis. While the sirolimuseluting Cypher stent appears to provide better outcomes than the paclitaxel-eluting Taxus stent in high-risk patient groups with complex lesions, such differences between the two DES are not apparent in the low-risk groups. Diabetic patients are generally prone to restenosis after percutaneous coronary intervention, but there are conflicting findings regarding the impact of diabetes mellitus on restenosis after DES implantation. The postintervention final lumen area continues to be the most important determinant of restenosis after DES implantation, indicating that a greater stented area contributes to a decreased rate of restenosis even in the DES era. Nonuniform strut distribution and stent fracture also contribute to the development of restenosis after DES implantation. In addition, the risk of restenosis increases linearly according to lesion length, and a "full metal jacket" approach in small vessels is related to a high risk of DES failure. Conclusion：Small vessel disease, diffuse disease and the type of DES are important predictors of restenosis after DES implantation. However, predicting restenosis remains difficult, and this indicates the need for further studies in order to ultimately identify those patients who are at high risk for DES failure.

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Section: Stent-related Factorsmentioning

confidence: 99%

Predictive Factors for Restenosis after Drug-Eluting Stent Implantation

Lee

Park

2007

Korean Circ J

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“…Many previous randomized studies have compared paclitaxel-and sirolimus-eluting stents [15][16][17][18][19][20][21][22][23][24][25] . However, in addition to the drug, the stents used in those studies differed in all other characteristics (coating and platform), which consequently prevented a more conclusive evaluation of the effects of the drugs themselves.…”

Section: Discussionmentioning

confidence: 99%

Fundamento e desenho do teste randomizado PAINT

Lemos

Moulin²,

Perin

et al. 2009

Arq. Bras. Cardiol.

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“…The angiographic restenosis rate was 9.4% for SES and 28.6% for PES (Pϭ0.02). 35 They showed that SES were more useful in reducing 6-month restenosis (3.3% versus 14.6%; PϽ0.001) and 9-month target lesion revascularization (2.4% versus 7.2%; Pϭ0.012) compared with PES. The efficacy of DES was further identified in a study assessing outcomes of 352 long coronary lesions treated with "full metal jacket" stents (stented length Ն60 mm) that showed an SES restenosis rate of 13.7%.…”

Section: Chronic Total Occlusionsmentioning

confidence: 99%

Current Status of Percutaneous Coronary Intervention With Drug-Eluting Stents in Asia

Park

Kim

2008

Circulation

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I n the last 3 decades, there has been a revolutionary change in the treatment of coronary artery disease. Through advances in equipment and technical skills, percutaneous coronary intervention (PCI) is being applied to increasingly more complex patients and lesions. In particular, coronary stenting has emerged as an effective strategy to prevent recurrence after PCI. However, restenosis in the stented segment remained a major issue in coronary stenting. 1 The recent introduction of drug-eluting stents (DES) has dramatically reduced restenosis rates compared with bare metal stent (BMS) use. Large randomized clinical trials have confirmed the benefits of DES over BMS in terms of decreasing the incidence of in-stent restenosis and the need for repeat revascularization. 2-4 As a result, there has been a very rapid worldwide shift in the treatment of coronary stenosis from BMS to DES, including in most Asian countries. However, concern remains over late-occurring stent thrombosis after DES implantation. [5][6][7] The prevalence of coronary artery disease has increased considerably in Asian countries over the past several decades as a result of shifts toward a more "westernized" lifestyle. Accordingly, PCI with stents is a common procedure in Asia, with Ͼ300 000 cases performed each year. 8,9 The present article describes the current status of DES use in Asian countries using both published and unpublished data. A few randomized studies have been performed in Asian countries, allowing the examination of pertinent registries to explore issues relating to DES in Asian countries. However, this review article cannot cover the disparities of patient demographics, practice pattern, and outcomes in all the different Asian countries because of a striking lack of published data. In addition, within the scope of the current review, the majority of data may reflect the performance of advanced centers in which PCI is practiced by experienced operators. Use of DES in AsiaAlthough several types of DES are now available in Asian countries, 3 have been used the most: the sirolimus-eluting (SES; Cypher, Johnson & Johnson Cordis, Miami, Fla), paclitaxel-eluting (PES; Taxus, Boston Scientific, Natick, Mass), and zotarolimus-eluting (Medtronic Vascular, Inc, Santa Rosa, Calif) stents. These 3 DES slowly release potent antiproliferative drugs into the tissue from a nonresorbable polymer matrix completely covering the stent struts. The findings of large randomized clinical trials showing the restenosis reduction efficacy of these stents have led to their use in Asian countries. 2-4,10 These DES typically cost about US $2000 to $3000 compared with about US $700 to $1000 for a BMS. Some other DES were made by homegrown medical companies in China and India with proprietary DES designs.The penetration rate of DES use is diverse across countries, depending on the economic status, patient or physician preference, and availability of medical reimbursement and marketing. In developed countries such as Japan and Korea, DES make up almost 90% of co...

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Sirolimus-Eluting Stent Versus Paclitaxel-Eluting Stent for Patients With Long Coronary Artery Disease

Cited by 108 publications

References 33 publications

Predictive Factors for Restenosis after Drug-Eluting Stent Implantation

Predictive Factors for Restenosis after Drug-Eluting Stent Implantation

Fundamento e desenho do teste randomizado PAINT

Current Status of Percutaneous Coronary Intervention With Drug-Eluting Stents in Asia

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