EES Associated with Reduced MACE Compared with SES

SAN FRANCISCO, CALIF.—Results from two meta-analyses presented here Monday night showed that EES were associated with significantly reduced risk for MACE and early, late and 1-year definite stent thrombosis compared with SES.

In the first study, presented by Hyo-Soo Kim, MD, PhD, of Seoul National University Hospital in South Korea, researchers reviewed data comparing EES (Xience V, Boston Scientific) and SES (Cypher, Cordis) in six randomized, controlled trials (SORT-OUT4, EXCELLENT, ISAR-TEST4, ESSENCE-DM, BASKET PROVE, RESET) and three registries (LESSON1, Xsearch, Asian registry).

Compared with SES, EES reduced MACE by 13%. The incidence of cardiac death was not different between the two stents but Xience V was associated with reductions in MI and a 30% reduction in stent thrombosis. Xience V also was  associated with a statistically nonsignificant reduction in target lesion revascularization or target vessel revascularization, but Kim said there was a “definite trend” in favor of EES.

“Compared with Cypher, Xience V reduces MACE by lowering MI and stent thrombosis,” Kim said.

In the same session, Tullio Palmerini, MD, of Istituto di Cardiologia Policlinico S. Orsola in Bologna, Italy, presented a second meta-analysis comparing EES vs. SES that looked at incidence of stent thrombosis.

Overall, EES was superior for early definite stent thrombosis (RR=0.32; 95% CI 0.11-0.92) and late definite stent thrombosis (RR=0.34; 95% CI .08-1.22). EES also performed better at 1 year  compared with SES (RR=0.33; 95% CI 0.14-0.75).

Palmerini added that results from the Bern-Rotterdam Cohort Study showed that for definite stent thrombosis at 4 years, EES (1.4%) was superior to both SES (2.9%) and PES (4.4%). When researchers expanded the analysis to definite or probable stent thrombosis, EES was still superior to SES and PES, though the difference was not as great (see Figure).

“In randomized trials, EES significantly reduced the risk of deadly stent thrombosis compared with SES, but when a broader definition of definite/probable stent thrombosis is used, this difference becomes less evident,” he said. “Importantly, the difference is not limited to the late period, but is apparent as early as 30 days.”