Sirolimus- Versus Paclitaxel-Eluting Stents

[Pyankov Vasily]

Sirolimus- Versus Paclitaxel-Eluting Stents for the Treatment of Coronary Bifurcations: Results From the COBIS (Coronary Bifurcation Stenting) Registry

Objectives
We aimed to compare the long-term clinical outcomes of patients treated with sirolimus-eluting stents (SES) or
paclitaxel-eluting stents (PES) for coronary bifurcation lesions.
Background
There are limited data regarding comparisons of SES and PES for the treatment of bifurcation lesions.
Methods
Patients who received percutaneous coronary intervention for non-left main bifurcation lesions were enrolled
from 16 centers in Korea between January 2004 and June 2006. We compared major adverse cardiac events
(MACE [cardiac death, myocardial infarction, or target lesion revascularization]) between the SES and PES
groups in patients overall and in 407 patient pairs generated by propensity-score matching.
Results
We evaluated 1,033 patients with bifurcation lesions treated with SES and 562 patients treated with PES. The
median follow-up duration was 22 months. Treatment with SES was associated with a lower incidence of MACE
(hazard ratio [HR]: 0.53, 95% confidence interval [CI]: 0.32 to 0.89, p 0.01) and target lesion revascularization
(HR: 0.55, 95% CI: 0.31 to 0.97, p 0.02), but not of cardiac death (HR: 2.77, 95% CI: 0.40 to 18.99,
p 0.62) and cardiac death or myocardial infarction (HR: 0.97, 95% CI: 0.38 to 2.49, p 0.94). After
propensity-score matching, patients with SES still had fewer MACE and target lesion revascularization incidences
than did patients with PES (HR: 0.52, 95% CI: 0.30 to 0.91, p 0.02, and HR: 0.48, 95% CI: 0.25 to 0.91,
p 0.02, respectively). There was no significant difference in the occurrences of stent thrombosis between the
groups (0.7% vs. 0.7%, p 0.94).
Conclusions
In patients with bifurcation lesions, the use of SES resulted in better long-term outcomes than did the use of
PES, primarily by decreasing the rate of repeat revascularization.

http://content.onlinejacc.org/cgi/repri ... 6/1743.pdf