At 5 years, everolimus-eluting stent is superior to paclitaxel-eluting stent

After five years, patients undergoing PCI had better safety and efficacy outcomes if they received an everolimus-eluting stent (EES) compared with a paclitaxel-eluting stent (PES), according to the long-term analysis of a Dutch clinical trial.

The results, which were published online in JACC: Cardiovascular Interventions on July 22, confirmed previous findings at one and two years follow-up. The COMPARE trial evaluated a second-generation EES (XIENCE V from Abbott Vascular) and a second-generation PES (TAXUS Libert√© from Boston Scientific).

Between February 2007 and September 2008, lead researcher Pieter C. Smits, MD, of Maasstad Hospital in Rotterdam, and colleagues randomized 1,800 patients in the Netherlands to receive one of the stents. At baseline, the groups were well-balanced. The median age was 63, and 70 percent of patients were males.

At five years, the EES group had a 27 percent relative risk reduction in the primary endpoint of death, nonfatal MI and target vessel revascularization (TVR). The benefits of EES were evident in all subgroups, according to the researchers. Patients who received the EES had significantly lower rates of MI (7.0 percent versus 11.5 percent) and TVR (7.4 percent versus 11.4 percent), but the groups had similar mortality rates (9.0 percent in the EES group and 10.3 percent in the PES group).

In addition, 12.5 percent of patients in the EES group experienced cardiac death, MI or clinically driven target lesion revascularization compared with 18.2 percent of patients in the PES group.

The researchers cited a few limitations, including that the results may not be applicable to all settings because the trial took place at one, high-volume, tertiary center. They also mentioned that PES is uncommon and that the study could not reliably estimate adverse events such as death or stent thrombosis.