Which of these new third-generation stents is better?

This study compared the effectiveness and safety of two third-generation stents to see whether one was better than the other. 

Stent angioplasty or percutaneous coronary intervention (PCI), is surgery carried out on patients with coronary artery disease. Coronary artery disease refers to a condition where the blood vessels that supply the heart with blood, oxygen and nutrients, are narrowed, often due to cholesterol buildup.

Stent angioplasty involves the insertion of a small flexible tube into the affected blood vessel, normally in the groin area. The tube is moved along the blood system until it reaches the narrowed artery and a small balloon within the tube is then inflated in the artery to dilate it and improve blood flow. This helps prevent heart related events such as a heart attack and cardiac death. Sometimes the stent is a drug-eluting stent that slowly releases a drug over time to help prevent the blockage from recurring and reduce the likelihood of a patient needing repeat stenting.

Examples of new ‘third-generation’ drug eluting stents include ‘Resolute Integrity’ that releases the drug zotarolimus and ‘Promus Element’ that releases the drug everolimus. All stents work to prevent narrowing of arteries but they differ in material, drug and time course of drug release.

This study investigated whether the zotarolimus-releasing stent or the everolimus-releasing stent works more safely and effectively than the other. 

A total of 1,811 patients who required stent angioplasty were randomly assigned one of the two types of stents. The clinical outcomes of the stents were measured 12 months after angioplasty surgery. 

The study found the stenting was deemed a failure (including the occurrence of heart attack, cardiac-related death or needing restending surgery) in 6% of the 906 patients who received the zotarolimus-releasing stent. Similar outcomes were met in 5% of the 905 patients who received the everolimus-releasing stent. 

Blood clots are side effects of stents (stent thrombosis) and the study found that stent blood clots occurred in 3 patients (0.3%) who received the zotarolimus-releasing stent, and 6 patients (0.7%) who received the everolimus-releasing stent. One everolimus-releasing stent also became deformed but this was not associated with side effects.

The study concluded that both stents had similar safety and effectiveness and provided excellent clinical outcomes in preventing heart complications such as heart attack and stroke. 

Even though this study included a large number of participants, there was a relatively low frequency of stent failure. This shows that the stents work extremely well but it makes it hard to distinguish differences between the two different types of stents. Therefore larger studies are needed to see if there is a significant difference between the effectiveness of the two stents. 

If you or someone you know need stent angioplasty, talk to your doctor about the possibility of receiving new zotarolimus-releasing or the everolimus-releasing stents.