Study highlights efficacy of sirolimus stents to prevent restenosis for PTS with CAD

Coronary stents coated with the immunosuppressive drug sirolimus are more likely to protect patients with coronary artery disease against future narrowing of coronary arteries (restenosis) than conventional metal stetns, conclude authors of a randomised trial in this week's issue of THE LANCET.

The implantation of coronary stents (to widen coronary arteries) has become the treatment of choice over the past decade for the treatment of coronary artery disease. Joachim Schofer from The Centre for Cardiology and Vascular Intervention, Hamburg, Germany, and colleagues studied 352 patients in whom one coronary artery required treatment (with diameter 2•5-3•0 mm and lesion length 15-32 mm). Half of patients received sirolimus-eluting stents, the other half conventional bare-metal stents.

At 8 months follow-up, the minimum diameter of treated coronary arteries was significantly greater among patients treated with sirolimus-eluting stents than those given bare-metal stents (2.2 and 1.3 mm, respectively). The rate of restenosis was significantly reduced with sirolimus-eluting stents compared with control stents (6% and 42%, respectively).

Fewer patients with sirolimus-eluting stents had major adverse cardiac events at nine-months follow-up compared with patients given bare-metal stents (8% and 23%, respectively).

In an accompanying Commentary (p 1088), Ulrich Sigwart from University Hospital, Geneva, Switzerland, concludes: "The advent of drug delivery from intravascular stents is a major advance in medicine. With this technology, endoluminal therapy is likely to produce similar or even better results than bypass surgery in most patients, not in a selected few. The way this technology is being delivered, however, may have to be revisited. The vehicle for drug delivery, the stent, is clearly under-engineered at the moment. There is plenty of leeway in stent technology before bare-metal stents get consigned to the dustbin. Bad stents should not be promulgated to patients as the ultimate achievement just because of their glossy paintwork."

Contact:
Professor Joachim Schofer, Center for Cardiology and Vascular Intervention, Othmarscher Kirchenweg 168, D-22763, Hamburg, Germany, T)49- 40-889-0090; F)49-40-880-3439; E) schofer@center-for-cardiology.de.
Professor Ulrich Sigwart, Cardiology Centre, University Hospital, CH-1211 Geneva, Switzerland; T) +41-22-372-7192; F) 41-22-372-7229; E) Ulrich.Sigwart@hcuge.ch.

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