Treatment of Left Anterior Descending Coronary Artery Disease With Sirolimus-Eluting Stents

Abstract

Background-Revascularization strategies often hinge on the presence and degree of left anterior descending coronary artery (LAD) stenosis. A decision for bypass surgery is often based on the durability of surgical LAD revascularization compared with percutaneous approaches. By decreasing restenosis, drug-eluting stents may have reduced the "reintervention gap" between surgery and percutaneous intervention, making the percutaneous route preferable. Methods and Results-Of the 1101 patients in the SIRIUS trial, 459 with an LAD stenosis were randomized to percutaneous intervention with either sirolimus-eluting or bare-metal stents. Baseline demographic, clinical, and angiographic data were obtained. Patients had 1-year clinical and 8-month angiographic follow-up. Baseline characteristics were similar in both groups. The majority of lesions were tubular type B lesions (69.7%) with a mean diameter of 2.73 mm and a mean length of 14.0 mm. The binary in-stent restenosis rate was 2% for the sirolimus stent group and 41.6% for the bare-metal arm (relative risk, 0.05; 95% CI, 0.02 to 0.1; PϽ0.001). One-year major adverse events (defined as cardiac death, Q-wave and non-Q-wave myocardial infarction, or target vessel revascularization) was decreased 59% in the sirolimus-stent group (9.8% versus 24.9%; relative risk, 0.39; 95% CI, 0.26 to 0.61; PϽ0.001). Subgroup analysis of 135 patients with proximal LAD lesions showed similar benefits. In-stent restenosis was 0 in the proximal LAD sirolimus-eluting group (nϭ67), compared with 38% in the bare-metal arm (nϭ68), and major adverse events demonstrated a similar trend, with a 50% decrease compared with control patients (10.4% versus 20.6%, PϭNS). Conclusions-Sirolimus-eluting stents significantly decrease revascularization rates in LAD lesions. At 1 year, sirolimuseluting stent revascularization rates are comparable to historic single vessel bypass surgery revascularization rates.

Revascularização da descendente anterior proximal com stents revestidos por fármacos

“…Both show similar final outcomes with the two strategies: a low MACE and similar TVR rate are observed in one of the studies (1.7% vs. 5.9%), and a slightly less favorable result (although quite better than that observed with baremetal stents) for PCI in the other study (14% vs. 2%). Final outcomes of the Sirius and Taxus IV RCT are also available, as regards the subgroup with PAD disease 5,6 . At the end of one year, the TVR rate is 6.0% and 7.9%, respectively.…”

“…In recent RCT, the use of DES with Sirolimus and Paclitaxel in the treatment of PAD resulted in low rates of TVR, of 6.0% and 7.9%, respectively 5,6 , at the end of one year, which leads to the hypothesis that DES will likely reduce or even outweigh the only advantage offered by the surgical treatment of PAD coronary artery disease.…”

Treating in-stent restenosis with drug-eluting balloon with intracoronary ultrasound control, with later optical coherent tomography control

“…Wprowadzenie stentów uwalniających leki (ang. drug eluting stent, DES) wyraźnie zmniejszyło jej częstość [1,2]. Niestety zabiegi PCI dotyczące zmian złożonych, długich, a szczególnie bifurkacji, wiążą się z wciąż relatywnie dużym ryzykiem restenozy oraz potrzeby ponownej rewaskularyzacji.…”

A Chicken in Every Pot and a Drug-Eluting Stent in Every Lesion

“…In fact, patients in SIRIUS who underwent DES of the left anterior descending artery had an angiographic restenosis rate (Ͼ50% diameter stenosis at follow-up) of only 2%. 5 Thus, for many patients, DES now makes stenting competitive with the long-term outcome after internal mammary artery implantation. Indeed, at Scripps Clinic, since Food and Drug Administration (FDA) approval of the first DES in April 2003, referrals for stenting have increased by Ͼ40%, and correspondingly, bypass surgery rates have begun to decline.…”