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#1
05.09.2006, 20:18
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Drug-Eluting Stent Mortality Meta-Analysis
Presented by A.J. Nordmann, European Society of Cardiology Scientific Congress, September 2006.
DescriptionThe goal of the study was to evaluate treatment with drug-eluting stents (DES) compared with bare-metal stents (BMS) on mortality among randomized trials of DES in patients undergoing percutaneous coronary intervention (PCI) for de novo coronary lesions. Drugs/Procedures UsedData were drawn from 17 randomized trials of DES compared with BMS. Endpoints evaluated were total mortality, cardiac mortality, and noncardiac mortality. Trials had to be randomized with follow-up of ≥1 year to be included in the meta-analysis. Principal FindingsTotal mortality at 1 year did not differ between BMS compared with DES (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.66-1.34) or for the individual type of stents: sirolimus-eluting stents (SES) OR 0.86, 95% CI 0.49-1.51; paclitaxel-eluting stents (PES) OR 0.98, 95% CI 0.64-1.48. At 3 years, total mortality trended toward higher rates with DES compared with BMS (OR 1.25, 95% CI 0.91-1.73) as well as with SES versus BMS (OR 1.48, 95% CI 0.91-2.42). Cardiac mortality at 3 years did not differ with DES versus BMS (OR 1.00, 95% CI 0.62-1.60). Noncardiac mortality at 3 years was directionally but not significantly higher with DES versus BMS (OR 1.45, 95% CI 0.93-2.25). However, for the individual stent type comparison, SES was associated with significantly higher rates of noncardiac death compared with BMS at both 2 years (OR 2.74, 95% CI 1.22-6.13, p < 0.05) and 3 years (OR 2.04, 95% CI 1.00-4.15, p < 0.05). Interpretation. In a meta-analysis of 17 randomized trials of patients undergoing PCI for de novo coronary lesions, treatment with DES was not associated with a significant difference in total mortality at 3 years, but was associated with increased noncardiac mortality with SES compared with BMS. Randomized trials of DES compared with BMS in de novo coronary lesions have consistently shown reductions in the need for repeat revascularization due to restenosis. However, none has been adequately powered to evaluate harder endpoints of death or myocardial infarction (MI). Restenosis, while a negative consequence of PCI, is a nonfatal event. The present meta-analysis demonstrates a potential but nonsignificant hazard in late mortality with DES, possibly attributable to higher late stent thrombosis. Longer-term follow-up from these trials will provide further insight, as will a more detailed analysis of the specific causes of death. Another recent meta-analysis presented at European Society of Cardiology Scientific Congress 2006 demonstrated higher rates of long-term death or Q-wave MI with SES compared with BMS. 
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#2
20.09.2006, 09:49
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а вот еще из обсуждения: для нашего здравоохранения в самое время.
 ESC Event News 5 September 2006 The drug eluting stents debate - Hot Line Session Results TWO SEPARATE, independent meta-analyses - presented in Hot Line session I at the World Congress of Cardiology 2006 - bring the long-term safety of DES firmly into the spotlight. Discussant Salim Yusuf (McMaster University, Canada) hailed the data as one of the most important presentations to come out of this year’s meeting. “Six million people in the world have been implanted with DES, yet their long-term safety and efficacy is unknown,” said Yusuf. “I’ve a feeling the data we’re seeing today is only the tip of the iceberg. We need to encourage more public access to the data.” Edoardo Camenzind Presenter, Edoardo Camenzind (Geneva, Switzerland), said recent case reports had flagged up the problem of in-stent thrombosis resulting from DES. The BASKET-LATE data showed that the rate of cardiac death and nonfatal myocardial infarction (MI) was higher in patients with DES than in those with bare metal stents (BMS) (p=0.01). “The problem is likely to be significantly under-reported, since if people die on the street they don’t fulfil the angiographic criteria to be classified as in-stent thrombosis.” The second presenter, Alain Nordmann (Basel, Switzerland), had concerns that DES accounted for more than 90% of stents used in the USA and Switzerland now. Camenzind undertook a meta-analysis looking at death and Q-wave MI in all randomised DES trials where data were available. Results at the latest available followup (four years) showed the incidence of death or MI was 6.3% for the sirolimus stent and 3.9% for the control BMS stent (p=0.03). For the paclitaxel stent, rates were 2.6% compared to 2.3% for the BMS stent (p=0.68). He concluded that death and Q-wave MI were higher in firstgeneration DES than BMS. He stressed that the problem was in first-generation DES – sirolimus and paclitaxel – and might not arise in the second-generation. In the second study, Nordmann undertook a meta-analysis of all randomised, controlled, first-generation DES trials comparing cardiac and non-cardiac deaths in DES versus BMS. At four years overall mortality was higher for both cardiac and non-cardiac deaths in DES patients. Of the 36 non-cardiac deaths identified, 15 were due to cancer, including lymphoma and cancers of the lung, prostate, pancreas, GI, kidney and rectum. “At this time, we can’t prove a causal relationship, only a statistical association. What makes me concerned is how difficult it was to obtain this data from the manufacturer,” said Nordmann. He speculated that the increase in cancer might be due to a rapid impairment of the immune system. Yusuf widened the debate to include percutaneous coronary intervention (PCI). “The overuse of PCI is an insidious change in the culture of cardiology that needs to be reversed,” he said. The use of PCI was established in MI, high-risk unstable angina and cardiogenic shock. However, its use in stable disease was a totally different question. “There’s no beneficial influence on mortality – PCI does nothing to prevent heart attack. All we are doing is providing short-term relief of chest pain. It’s not re-stenosis that kills but the thousands of lesions you can’t see. Stable angina can be controlled with full medical management.” Yusuf said vested interests included pharmaceutical companies, who have invested billions of dollars in DES, and cardiologists in the US and Canada who are reimbursed according to PCI procedures undertaken. He called for Euro Heart Surveys to provide clear evidence on when PCI was needed, predicting the majority of indications would be uncertain. Jean Marco, chairperson of the PCI Euro Heart Survey, said that the Euro Heart Survey had outlined evidence-based indications for PCI. “These meta-analyses shouldn’t be viewed as detracting from the value of PCI and DES, but promoting a precautionary attitude towards the indiscriminate use of first generation DES.” Related Report and Slides Available Reference: Source: ESC Congress News - 05/09/2006
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#4
13.11.2006, 06:31
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Мне все равно DES, или не DES. Разница ничтожна - примерно 1% в год. Для меня проблема только в том, что пациента со стентом, особенно DES нужно держать на Плавиксе с аспирином. Поэтому уже год как направляя пациентов к кардиологам я пишу, что пациент НЕ КАНДИДАТ на длительный прием Плавикса, следовательно никто DES ему ставить не будет.
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#5
14.11.2006, 00:16
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Цитата:
1. "However, until proved otherwise, PCI should be used only with reservation in diabetics with multy-vessel disease and in patients with unprotected LM stenosis. The use of drug-eluting stents might change this situation." В гайде по ТБКА надеятся, что покрытые стенты расширят показания для ТБКА и позволят стентировать не только диабетиков и пациентов с неприкрытым стенозом ПНА, но и другие стенозы. Они дипломатично надеятся. А на самом деле, в реальной жизни, уже как 4-5 лет покрытые стенты ставят направо и налево без чётких обоснований. 90% стентов - это DES. Около 10% - у диабетиков и при unprotected LM stenosis. Просто потому, что потом удобно и красиво показывать пациенту картинки "до" и "после" со словами "Вы были очень больны, а теперь Вы здоровы". Слоган для Cordis and Boston: "каждый последующий третий стент мы установим Вам бесплатно!" 2. Мне кажеться, что эта шумиха вокруг DES очень полезна и позволит более трезво отнестись к установке любых стентов.
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#6
14.11.2006, 22:34
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Открытие окклюзии на 3-28 день после ИМ vs медикаментозное лечение
Occluded Artery Trial (OAT – Presented at AHA 2006 )
Year Presented 2006 Year Published 2006 Description The goal of the trial was to evaluate percutaneous coronary intervention (PCI) compared with medical therapy among stable, high-risk patients with persistent total occlusion of the infarct-related artery post-myocardial infarction (MI). Hypothesis A strategy of routine PCI for total occlusion of the infarct-related artery 3-28 days after acute MI would reduce the occurrence of the composite of death, reinfarction, or New York Heart Association (NYHA) class IV heart failure. Drugs/Procedures Used Patients with persistent total occlusion of the infarct-related artery 3-28 days post-MI were randomized to PCI with stenting (n = 1,082) or medical therapy (n = 1,084). A core laboratory evaluated the qualifying angiogram. Concomitant Medications Aspirin, anticoagulation if indicated, angiotensin-converting enzyme inhibitors, beta-blockers, and lipid-lowering therapy, unless contraindicated Principal Findings Intial treatment with thrombolytic therapy was used in 19% of patients within the first 24 hours of the index MI. Median time from MI to randomization was 8 days. PCI was successful in 87% of the PCI cohort. Stents were used in 87% of patients, 8% of which were drug-eluting stents, and glycoprotein IIb/IIIa inhibitors in 72%. PCI was performed in 3% of the medical therapy cohort. Medication use at discharge was similar between the groups, with the exception of thienopyridine use, which was higher in the PCI group. The primary endpoint of death, reinfarction, or NYHA class IV heart failure occurred in 17.2% of the PCI group and 15.6% of the medical therapy group (hazard ratio [HR] 1.16, p = 0.20). Total reinfarction trended higher in the PCI group (7.0% vs. 5.3%, HR 1.36, p = 0.13), as did nonfatal reinfarction (6.9% vs. 5.0%, HR 1.44, p = 0.08). Repeated elevation of cardiac biomarkers within 48 hours of randomization occurred significantly more frequently in the PCI group (10.0% vs. 3.3%, p < 0.001). There was no difference in the individual endpoints of death (9.1% for PCI vs. 9.4% for medical therapy, p = 0.83) or NYHA class IV heart failure (4.4% vs. 4.5%, p = 0.92) between the treatment groups. Interpretation Among stable, high-risk patients with persistent total occlusion of the infarct-related artery post-MI, performance of PCI 3-28 days post-MI was not associated with a difference in the composite of death, reinfarction, or NYHA class IV heart failure through a mean follow-up of 3 years compared with medical therapy. Despite no reduction in the composite endpoint, PCI was associated with a trend toward higher rates of reinfarction compared with medication therapy. The reinfarctions were not only procedural-related infarcts (i.e., early procedural enzymatic leaks), but true ST elevation reinfarctions that accumulated throughout follow-up. One explanation for the trend toward an increase in reinfarctions with PCI may be embolization resulting in myocardial damage and impaired collateral flow. Presence of persistent total occlusion remains a problem for a sizeable cohort of patients for whom suitable treatment is lacking. Early reperfusion therapy, the goal of ST elevation MI treatment, with either primary PCI or thrombolysis, is not indicated for patients who present late, often with persistent total occlusion. The present study, the largest randomized trial to date in this population, does not support the hypothesis of late PCI for stable but persistent total occlusion.
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#7
14.11.2006, 22:51
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Наверное успеха не было, т.к. "Stents were used in 87% of patients, 8% of which were drug-eluting stents..."
 Полный текст в [Ссылки доступны только зарегистрированным пользователям ]ЗЫ: Что-то наши инвазивные коллеги не спешат высказаться...
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#9
07.09.2007, 10:48
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Цитата:
Possible mechanisms for risk in STEMI Speculating on the possible mechanisms driving the higher risk of DES in STEMI patients, Steg pointed to data suggesting that large thrombus burden is an independent predictor of complications and increased mortality and to the fact that DES are known to profoundly delay reendothelialization in the stented segment. "In the acute infarct situation, not only do you have the large thrombus burden and a nonreendothelialized surface, you also will tend to have some platelet constriction and thrombus in the vessel, which will result in possible undersizing of the stent when you use a DES," Steg said. "When you have a bare-metal stent, undersizing is not very important because you're going to have restenosis that's going to prevent stent thrombosis. But when you have a DES, that creates the potential for gaps between the stent struts and the vessel wall as the vessel enlarges and remodels. It has been shown that the frequency of acquired late stent malapposition in the vessel wall is far greater with DES than bare-metal stents. . . and that's a strong prognostic marker for the risk for stent thrombosis, particularly since stents are not properly reendothelialized up to three years." [Изображения доступны только зарегистрированным пользователям] [Изображения доступны только зарегистрированным пользователям]Commenting on the study for heartwire, Dr Kurt Huber (Wilhelminen Hospital, Vienna, Austria) emphasized that STEMI is a clear off-label indication. As such, he said the GRACE analysis "isn't really new information, because we always were a little bit afraid of using DES in STEMI patients. Now we are getting information from registries that patients who have this high thrombotic risk also have this high adverse outcome. So it's not really astonishing. We really should stay within the correct indications with DES. We still believe these stents are important for patients with small vessel diameters and long lesions, but that's it so far." Also unsurprised by the results was Dr Spencer King (Emory University School of Medicine, Atlanta, GA), who early on defended a role for bare-metal stents and urged restraint when DES mania was first sweeping the US, UK, and Europe. The findings from the GRACE registry are in keeping with what many people had predicted would happen if DES were used off-label in STEMI patients, given the different pathogenesis of acute MI, King said. "Many people are still using drug-eluting stents for ACS; these registry results should cause them to reconsider that practice," he told heartwire. GRACE after SCAAR During a press conference announcing the results, Steg rejected the suggestion that his findings seem at odds with the somewhat heartening new results from the SCAAR registry, released earlier this week. That registry, he pointed out, looked at all recipients of DES, not just STEMI or ACS patients, yet the survival curves reported by the Swedish investigators showed a similar pattern of divergence over time. Moreover, the GRACE analysis looked only at mortality post-hospital discharge, thereby avoiding any bias related to the choice of stent in patients who ultimately died in the hospital. "I suspect that the initial in-hospital benefit that you see in SCAAR, which by the way we also saw in our study, is related to the lower base risk score that patients with DES often have. What happens is that dying patients will never get a DES: dying patients will always get a bare-metal stent, so there is a bias in the initial survival related to the selection of candidates for DES. Once you censure that, and you start counting the deaths after hospital discharge, you actually see a worrying trend, even in the SCAAR data. In fact, I think the data are remarkably similar." But Steg, at the outset of his presentation, noted that his group had chosen to focus on STEMI patients after performing an initial analysis of non-STEMI/unstable-angina patients and finding no differences in mortality between DES and bare-metal-stent-treated patients. Whereas all-cause mortality in patients with STEMI was 1.6% for bare-metal-stent-treated patients and 8.6% for DES-treated patients (p<0.001), in non-STEMI patients, those numbers were 3.9% and 2.9% (p=0.5). Discussing the results, Dr William Wijns (Cardiovascular Center, OLV Hospital, Aalst, Belgium) pointed out that the NSTEMI results are the good news. "Non-STEMI is a class 1 indication for PCI, and the GRACE registry shows no evidence for increased mortality with DES at any time period." The bad news is that STEMI is also a class 1 indication for PCI, yet the GRACE registry suggests that the mortality risk associated with DES may be more than sixfold greater than that of bare-metal stents. To further complicate the issue, Wijns showed an analysis he obtained from the SCAAR registry investigators looking only at STEMI patients treated with DES, which indicated that the relative risk of death in more than 35 000 patients was 1.02 (95% CI 0.86-1.21). Three-year follow-up from yet another randomized trial of DES vs bare-metal stents in AMI, the STRATEGY trial, presented earlier at this meeting by Dr Marco Valgimigli (University of Ferrara, Italy), also showed no differences in mortality rates between the two stent groups. "These conflicting data should not confuse you," Wijns said. "Patients in trials and registries are different, and these differences are associated with differences in outcome. The strongest determinant of outcome is the case mix. In any registry the decision to treat a patient with a DES or bare-metal stent is a reflection of clinical decision-making, so you can't blame it all on the device." Wijns concluded, "It will take no less than large properly designed outcome-based randomized trial to sort out this issue." In the meantime, "DES should be used only when they are demonstrated to have a neutral or beneficial effect on mortality and rates of MI, as compared with bare-metal stents."
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#10
09.09.2007, 18:29
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Цитата:
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#11
11.09.2007, 22:47
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Цитата:
Ведь кроме этого регистра (в котором даже непонятно какие именно покрытые стенты использовались) есть как минимум четыре исследования (Strategy, Typhoon, Sesami, Passion), доказывающие обратное. Но скорее всего, решающим в этом вопросе могут стать данные исследования Horizons AMI, где рандомизировано более 3000 пациентов.
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#12
17.09.2007, 13:21
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DES vs BMS: мета-анализ от Lancet.
Christoph Stettler et al. Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet 2007; 370: 937–48 Background Whether the two drug-eluting stents approved by the US Food and Drug Administration—a sirolimus-eluting stent and a paclitaxel-eluting stent—are associated with increased risks of death, myocardial infarction, or stent thrombosis compared with bare-metal stents is uncertain. Our aim was to compare the safety and eff ectiveness of these stents. Methods We searched relevant sources from inception to March, 2007, and contacted investigators and manufacturers to identify randomised controlled trials in patients with coronary artery disease that compared drug-eluting with bare-metal stents, or that compared sirolimus-eluting stents head-to-head with paclitaxel-eluting stents. Safety outcomes included mortality, myocardial infarction, and defi nite stent thrombosis; the eff ectiveness outcome was target lesion revascularisation. We included 38 trials (18 023 patients) with a follow-up of up to 4 years. Trialists and manufacturers provided additional data on clinical outcomes for 29 trials. We did a network meta-analysis with a mixed-treatment comparison method to combine direct within-trial comparisons between stents with indirect evidence from other trials while maintaining randomisation. Findings Mortality was similar in the three groups: hazard ratios (HR) were 1·00 (95% credibility interval 0·82–1·25) for sirolimus-eluting versus bare-metal stents, 1·03 (0·84–1·22) for paclitaxel-eluting versus bare-metal stents, and 0·96 (0·83–1·24) for sirolimus-eluting versus paclitaxel-eluting stents. Sirolimus-eluting stents were associated with the lowest risk of myocardial infarction (HR 0·81, 95% credibility interval 0·66–0·97, p=0·030 vs bare-metal stents; 0·83, 0·71–1·00, p=0·045 vs paclitaxel-eluting stents). There were no signifi cant diff erences in the risk of defi nite stent thrombosis (0 days to 4 years). However, the risk of late defi nite stent thrombosis (>30 days) was increased with paclitaxel-eluting stents (HR 2·11, 95% credibility interval 1·19–4·23, p=0·017 vs bare-metal stents; 1·85, 1·02–3·85, p=0·041 vs sirolimus-eluting stents). The reduction in target lesion revascularisation seen with drug-eluting stents compared with bare-metal stents was more pronounced with sirolimus-eluting stents than with paclitaxel-eluting stents (0·70, 0·56–0·84; p=0·0021). Interpretation The risks of mortality associated with drug-eluting and bare-metal stents are similar. Sirolimus-eluting stents seem to be clinically better than bare-metal and paclitaxel-eluting stents. Полный текст - [Ссылки доступны только зарегистрированным пользователям ]
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#13
17.09.2007, 18:12
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Цитата:
Цитата:
Цитата:
[Изображения доступны только зарегистрированным пользователям] Из них три с сайфером, одно с таксусом... [Ссылки доступны только зарегистрированным пользователям ] Ни в одном из них не было продемонстрировано преимущество DES над Bare в отношении летальности в период до 12 мес. (как стало недавно известно, основные проблемы с ДЕСами начинаются после года. Если вспомнить GRACE, расхождение начинается спустя год и идет по "нарастающей" еще два года) [Ссылки доступны только зарегистрированным пользователям ] Нет разницы и по реинфаркту (опять таки, до 12 мес.) Зато есть достоверная разница по TVR (кроме PASSION с таксусом) [Ссылки доступны только зарегистрированным пользователям ] Наиболее часто в качестве доводов DES при ОИМ цитируется "Тайфун" (оно и понятно - больше всего пациентов), однако в исследование не включались пациенты с Киллип 2 и больше, перенесшие инфаркт миокарда, с фракцией выброса менее 30%, с выраженной извитостью и кальцинозом целевого сосуда... При этом в PASSION достоверной разницы в TVR TLR не получилось, возможно потому, что там использовался несколько другой дизайн исследования: включались пациенты с ФВ менее 30%, с выраженной извитостью сосудов, кальцификацией, стенозами >30 мм. Кроме этого использовался более конкретный Bare стент Express2/Liberte нежели "any" в Тайфуне. Поэтому, наверное, напрямую Пассион и Тайфун сравнивать некорректно. ........
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#14
17.09.2007, 20:39
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Цитата:
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#15
21.09.2007, 09:27
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Largest Study to Date Finds Drug-Eluting Stents and Bare-Metal Stents Yield Similarly Low Mortality Rates
Authors Also Conclude the CYPHER® Sirolimus-eluting Coronary Stent Clinically Superior to Bare-Metal Stents and the Taxus Stent When Safety and Effectiveness Outcomes in this Analysis are Considered WARREN, NJ – September 13, 2007--A network meta-analysis of 38 randomized controlled trials encompassing more than 18,000 patients found that the mortality risks associated with drug-eluting stents and bare-metal stents are similarly low. This analysis, the largest of its kind to date comparing drug-eluting stents (the CYPHER® Sirolimus-eluting Coronary Stent and the Taxus Stent) to bare-metal stents, appears this week in the medical journal The Lancet. The analysis also found a substantial reduction in the risk of myocardial infarction (heart attack) and reintervention with the CYPHER® Stent when compared to bare-metal stents and the Taxus Stent, and no significant differences in the rates of stent thrombosis (blood clots) between the CYPHER® Stent and bare-metal stents. The data from this analysis also identified a significant decrease in the risk of blood clots occurring more than 30 days after stent implantation with the CYPHER Stent compared to the Taxus Stent. “This large set of data indicates that the mortality associated with drug-eluting stents and bare-metal stents is comparable. Recent concerns about increases in mortality associated with drug-eluting stents are not supported by this analysis assessing long-term outcomes,” stated Dr Christoph Stettler, M.D., from the University of Bern, Switzerland, one of the authors of the study. Dr. Stettler is with the Department of Endocrinology, Diabetes and Clinical Nutrition there. In addition, the corresponding author, Dr. Peter Juni, M.D., stated that, “These results have also led us to conclude that the CYPHER® Stent is clinically superior to bare-metal stents and the Taxus Stent when the safety and effectiveness outcomes in this analysis are taken into account.” Dr. Juni is Head of Division, Clinical Epidemiology and Biostatistics, University of Bern in Switzerland. Funded by the Swiss National Science Foundation, this network meta-analysis was designed to compare the safety and effectiveness of bare-metal stents, the CYPHER® Stent and the Taxus Stent in a large patient population to increase the ability to detect and understand low frequency events, such as death and stent thrombosis. It included data up to four years of follow-up. The safety outcomes comprised mortality (death), myocardial infarction and Academic Research Consortium (ARC) definite stent thrombosis. The effectiveness outcome was target lesion revascularization (or the need for a repeat intervention). The mortality rates were similar for all three stents: hazard ratios (HR) were 1.00 (95 percent credibility interval 0.82 to 1.25) for the CYPHER Stent versus bare-metal stents, 1.03 (CI 0.84 to 1.22) for the Taxus Stent versus bare-metal stents and 0.96 (CI 0.83 to 1.24) for the CYPHER Stent vs. the Taxus Stent. The CYPHER® Stent was associated with the lowest risk of myocardial infarction. The corresponding hazard ratios were 0.81 versus bare-metal stents (CI 0.66 to 0.97, p=0.030) and 0.83 versus the Taxus Stent (CI 0.71-1.00, p=0.045). The ARC definite stent thrombosis rates between the CYPHER® Stent and bare metal stents were not significantly different over the entire follow-up. However, the risk of late stent thrombosis (occurring more than 30 days after the procedure) was more than twice as likely with the Taxus Stent compared to bare-metal stents (HR 2.11, CI 1.19-4.23, p=0.017). In addition, the study found that a late stent thrombosis event was 46 percent less likely to occur in a patient implanted with the CYPHER® Stent than in a patient who received the Taxus Stent (HR 0.54, CI 0.26-0.98, p=0.041). While both drug-eluting stents were associated with significantly lower risks of target lesion revascularization compared to bare-metal stents, the CYPHER® Stent reduced the risk substantially further compared to the Taxus Stent. The CYPHER® Stent reduced the risk by 70 percent (HR 0.30, CI 0.24 to 0.37, p=0.0001) and the Taxus Stent by 58 percent (HR 0.42, CI 0.33 to 0.53, p=0.0001) compared to bare-metal stents. When the target lesion revascularization rate for the CYPHER® Stent was compared directly to the rate for the Taxus Stent, a patient implanted with the CYPHER® Stent was found to be 30 percent less likely to need another procedure than a patient treated with the Taxus Stent (HR 0.70, CI 0.56 to 0.84, p=0.0021). This difference is consistent with other meta-analyses of randomized controlled trials directly comparing the two stents. “This network meta-analysis constitutes the largest and most robust set of data published to date in an eminent international peer-reviewed journal assessing the long-term safety and efficacy outcomes of drug-eluting stents,” said David E. Kandzari, M.D., F.A.C.C., F.S.C.A.I., Chief Medical Officer, Cordis Corporation. “It significantly enriches the large body of evidence that interventional cardiologists have at their disposal to make the right choice for their patients. These data clearly demonstrate the benefits of drug-eluting stents versus bare metal stents and further provide clarity as to the differences between the CYPHER® Stent and the Taxus Stent.”
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Комбинированный вид
