September 20th, 2013
My Stent Is Better Than Your Stent
Richard A. Lange, MD, MBA and L. David Hillis, MD
In a meta-analysis of the final 3-year results of the international SPIRIT (Clinical Evaluation of the Xience V Everolimus Eluting Coronary Stent System in the Treatment of Patients With De Novo Native Coronary Artery Lesions) II, III, and IV clinical trials, coronary implantation of the everolimus-eluting stent (EES) was superior to the use of the paclitaxel-eluting stent (PES), with reduced rates of all-cause death, myocardial infarction (MI), ischemia-driven target-lesion revascularization (TLR), stent thrombosis, and target-lesion failure (a composite of cardiac death, target-vessel MI, and ischemia-driven TLR).
EES (%)(n=3350) |
PES (%)(n=1639) |
Hazard ratio |
P value |
|
Mortality |
3.2 |
5.1 |
0.65 |
0.003 |
MI |
3.2 |
5.1 |
0.64 |
0.002 |
Ischemia-driven TLR |
6.0 |
8.2 |
0.72 |
0.004 |
Stent thrombosis |
0.7 |
1.7 |
0.45 |
0.003 |
Target-lesion failure |
8.9 |
12.5 |
0.71 |
0.0002 |
1. With all the different stents available, how do you decide which stent(s) to use?
2. What factors affect your decision (i.e., product, patient, personal, cath lab stock, etc) ?
3. To what extent is your choice evidence-based? If 0% is personal opinion and 100% is entirely data-driven, how “evidence-based” is your choice?
4. Each stent manufacturer extols the virtues of its own product. Where do you get your information regarding stent superiority?
One Response to “My Stent Is Better Than Your Stent”
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Choice driven by hospital/system contracting, with that choice based on a cardiology technology subcommittee which takes into consideration efficacy, safety, and cost of the different available stents. The data that the committee utilizes is that which exists in the refereed literature- comparative studies, registries, or meta-analysis. Efficacy and safety always prevails above cost.