Are new versions of drug-eluting stents safer?

In this study, researchers compared the safety and efficacy of older versus newer versions of drug-eluting stents in patients with acute coronary syndrome.

In acute coronary syndrome (ACS), one or more blood vessels that provide oxygen to the heart (coronary arteries) are blocked by a blood clot. Drug-eluting stents (DES) are mesh tubes that hold open these blocked blood vessels and continuously diffuse a medication into the bloodstream that prevents cells from re-blocking the vessel. Older, “first generation” DES contain drugs like sirolimus (SES) or paclitaxel (PES), but newer, “second generation” DES include everolimus (EES) or zotarolimus (ZES). It is not well-understood whether second generation DES are superior to first generation DES in terms of efficacy and safety. This article aimed to evaluate which type of DES might provide patients with the most benefit.

This study included 2,757 patients with ACS from 6 randomized clinical trials investigating different DES. Overall, the newer DES were 40% less likely to cause blood clots (in-stent thrombosis) compared to “first generation” DES. However, patients treated with “second-generation” DES had a two times higher risk of needing a second DES placement in the same blood vessel. 

Of the two second generation DES, EES were generally safer than ZES. EES were 45% less likely to cause major adverse cardiac events (MACEs) such as heart attack, stroke or sudden death and reduced the risk of thrombosis by 61%. ZES, conversely, were 45% more likely to cause MACEs and twice as likely to require a second stent placement to improve blood flow in the coronary arteries.

In summary, of the two medications available in second generation DES – everolimus and zotarolimus – everolimus was associated with fewer adverse effects.

Talk to your doctor about the most appropriate treatment in your situation.