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Lower risk of heart attack from siromilus stents than paclitaxel or bare metal stents

Lancet

The mortatilty risks associated with drug-eluting and bare-metal stents for the heart are similar. However, siromilus-eluting stents give a lower risk of heart attack after implantation than either paclitaxel-eluting or bare metal stents. These are the conclusions of authors of an article in this week's edition of The Lancet.

Following the recent debate about increased risk of death and stent thrombosis associated with drug-eluting as compared with bare-metal stents, Dr Peter Jüni, Institute of Social and Preventive Medicine (ISPM),University of Bern, Switzerland, and colleagues did a meta-analysis (an analysis of several previous studies combined), which included 38 trials and data from 18023 patients, with a follow-up period of up to four years. Trialists and stent manufacturers also provided additional data on clinical outcomes for 29 trials.

The researchers found that mortality was similar in the three groups. However siromilus-eluting stents were found to give a reduced-heart attack risk of 19% versus bare-metal stents and 17% versus paclitaxel-eluting stents. And while there were no significant differences in the risk of definite stent thrombosis, the risk of late definite stent thrombosis (occurring more than 30 days after implantation) was more than twice as high for paclitaxel-eluting stents versus bare-metal stents, and 85% higher for paclitaxel-eluting stents versus siromilus-eluting stents. The authors found no evidence for an increase in the risk of late stent thrombosis for sirolimus-eluting as compared with bare-metal stents.

Both drug-eluting stents reduced the risk of target-lesion revascularisation compared with bare-metal stents: siromilus-eluting stents by 70%, and paclitaxel-eluting stents by 58%. Compared with paclitaxel-eluting stents, siromilus-eluting stents reduced this risk by 30%.

The authors say: "We conclude, therefore, that siromuilus-eluting stents seem to be clinically better than bare-metal and paclitaxel eluting-stents."

In an accompanying Comment, Drs Mark Webster and John Ormiston, Auckland City Hospital, Auckland, New Zealand, discuss the merits of the various stent strategies and how they could play a part in future treatment.

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The paper can be accessed through the link below:
http://multimedia.thelancet.com/pdf/press/Stents.pdf

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