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13-02-2011 | Cardiology | Article

Long-term CV outcomes similar with paclitaxel-eluting, bare-metal stent

Abstract

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MedWire News: Follow-up results from the PASSION trial suggest that similar long-term rates of major adverse cardiac events (MACE) occur when percutaneous coronary intervention (PCI) is performed with paclitaxel-eluting stents (PES) as with bare-metal stents (BMS).

As previously reported by MedWire News, initial findings from the PASSION (Paclitaxel-Eluting Versus Conventional Stent in Myocardial Infarction [MI] with ST-segment Elevation) trial showed no significant difference in 1-year post-PCI rates of MACE (defined as composite cardiac-related death, recurrent MI, or target lesion revascularization [TLR]) with PES compared with BMS.

"The present analysis shows there is still no significant difference observed through 5 years of follow-up," report Maarten Vink (Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands) and team.

The follow-up study, published in the Journal of the American College of Cardiology: Cardiovascular Interventions, involved 619 ST-elevation MI (STEMI) patients randomly allocated to undergo PCI with PES (n=310) or BMS (n=309).

Over a follow-up period of 5 years, MACE occurred at a similar rate of 18.6% versus 21.8% among PES and BMS patients, respectively. This, say Vink and colleagues, is equivalent to a nonsignificant 18% lower risk for MACE with PES compared with BMS.

No significant difference was observed in the overall 5-year rate of definite or probable stent thrombosis (ST) among patients in the PES group compared with those in the BMS group, at respective rates of 4.2% and 3.4%.

However, very late ST, defined as ST occurring beyond 1 year of PCI, was more frequent with the use of PES (3.5%) than BMS (1.1%).

Vink et al highlight that "in current clinical practice guidelines, the use of drug-eluting stents (DES) in acute STEMI is mentioned only as a method to reduce restenosis." But they add that European Society of Cardiology/American Heart Association guidelines "do not make a general recommendation for the use of DES in the setting of STEMI."

The researchers conclude: "The possibility of a higher risk of very late ST in PES supports the ambivalence of the guidelines on this matter, which needs to be substantiated in further clinical research."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Lauretta Ihonor

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