By Sahar Bedrood B.S. and Asher Kimchi M.D.

Bern, Switzerland- Sirolimus-eluting stents and paclitaxel-eluting stents are used for coronary revascularization and reduce the risk of restenosis more than bare metal stents. However, until a study by Stephan Windecker M.D. et al from the University Hospital Bern in Switzerland, there has been no comparison between the two types of drug-eluting stents. This study, published in the August 18, 2005 issue of The New England Journal of Medicine, found the use of sirolimus-eluting stents results in fewer major adverse cardiac events than paclitaxel-eluting stents. 

The study conducted a randomized, controlled, single-blind comparison of sirolimus-eluting and paclitaxel-eluting stents in 1012 patients undergoing percutaneous coronary intervention. The primary end point was considered death from cardiac causes, myocardial infarction and ischemia-driven revascularization of the target lesion by nine months.  

The rate of major adverse cardiac events at nine months was 6.2 percent in the sirolimus-stent group and 10.8 percent in the paclitaxel-stent group. The hazard ratio for the study was 0.56; 95 percent confidence interval, 0.36 to 0.86; P=0.009. The study contributed the difference to a lower rate of target-lesion revascularization in the sirolimus-stent group than in the paclitaxel-stent group (4.8 percent vs. 8.3 percent; hazard ratio, 0.56; 95 percent confidence interval, 0.34 to 0.93; P=0.03).  

The rate of death from cardiac causes was 0.6 percent in the sirolimus-stent group and 1.6 percent in the paclitaxel-stent group (P=0.15). The rates of myocardial infarction were 2.8 percent and 3.5 percent, respectively (P=0.49); and the rates of angiographic restenosis were 6.6 percent and 11.7 percent, respectively (P=0.02). 

In this randomized, controlled study, the use of sirolimus-eluting stents was associated with a 44 percent decrease in the risk of major adverse cardiac events as compared with the use of paclitaxel-eluting stents. The therapeutic effect of decreasing the rate of clinical and angiographic restenosis shows support for the use of sirolimus-eluting stents for coronary revascularization. 

Co-authors: Stephan Windecker, M.D., Andrea Remondino, M.D., Franz R. Eberli, M.D., Peter Jüni, M.D., Lorenz Räber, M.D., Peter Wenaweser, M.D., Mario Togni, M.D., Michael Billinger, M.D., David Tüller, M.D., Christian Seiler, M.D., Marco Roffi, M.D., Roberto Corti, M.D., Gabor Sütsch, M.D., Willibald Maier, M.D., Thomas Lüscher, M.D., Otto M. Hess, M.D., Matthias Egger, M.D., and Bernhard Meier, M.D.