CYPHER Vs TAXUS A Comparative Analysis of Late Loss Patterns in Drug-Eluting Stents

1. CYPHER Vs TAXUS • A Comparative Analysis of Late Loss Patterns in Drug-Eluting Stents

2. CYPHER Vs TAXUS • Authors • R.R. Sapra, U. Kaul, R.K. Gupta, B. Singh, T. Ghose, R. Kachru, R.B. Thasan. • Institution • Batra Hospital and Medical Research Centre, New Delhi, India

3. CYPHER Vs TAXUS • Background • Drug-eluting stents have emerged as a potential solution for the prevention of restenosis. • Both sirolimus- and paclitaxel-eluting stents have shown significant reduction in restenosis. • Objective • To evaluate and compare the patterns of late loss in sirolimus- (Cypher, Cordis Europa, The Netherlands) and paclitaxel-eluting (Taxus, Boston Scientific, Galway, Ireland) stents.

4. CYPHER Vs TAXUS • Patients • 288 patients (pts) with 299 lesions • Treatment period: June 2002 to April 2003 • Stents Used • 191 Cypher and 152 Taxus stents. • Ten predictors of late loss were studied.

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6. CYPHER Vs TAXUS • Baseline Features • Mean lesion length was 18.9 ± 6.9 mm and 17.1 ± 3.6 mm for the Cypher and the Taxus stents, respectively. • Mean reference vessel diameter (RVD) was 2.81 ± 0.26 mm and 2.97 ± 0.35 mm for the Cypher and the Taxus stents, respectively.

7. CYPHER Vs TAXUS Mean lesion length was 18.9 ± 6.9 mm and 17.1 ± 3.6 mm for the Cypher and the Taxus stents, respectively.

8. CYPHER Vs TAXUS Mean Reference Vessel Diameter was 2.81± 0.26 mm and 2.97 ± 0.35 mm for the Cypher and the Taxus stents, respectively.

9. CYPHER Vs TAXUS • Current status • Follow-up angiography with qualitative coronary angioplasty is being performed in all pts after 6 months. • Data for 63 consecutive pts (44 Cypher and 23 Taxus) and 70 lesions (46 Cypher and 24 Taxus) were presented at the TCT 2003.

10. CYPHER Vs TAXUS • Results • Late loss, of more than 25%, in the stented segments* was analyzed and observed in: • 29.2% of Taxus • 19.6% of Cypher stents (p = NS). • Angiographic restenosis (>50% diameter stenosis) was observed in 8.3% of Taxus and 10.8% of Cypher stents (p = NS). • Late loss was focal (< 10 mm long) in all pts. *stent and 5 mm proximal and distal to it

11. CYPHER Vs TAXUS Angiographic restenosis (>50% diameter stenosis)

12. CYPHER Vs TAXUS • Results (Cont…) • Late loss in the Taxus stents was present only inside the stent, with no edge effect. • In the Cypher stents, however, the late loss was observed inside the stent in 44.4% lesions and predominantly in the peristent region in the remaining lesions.

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14. CYPHER Vs TAXUS • Univariate analysis factors that appeared to predict late loss were: • presence of diabetes • lesion length >20 mm • (p = 0.07 and 0.09, respectively).

15. CYPHER Vs TAXUS • Conclusion • Late loss of more than 25% tends to occur more often with Taxus stents compared with Cypher stents. • This did not increase the incidence of 6-month angiographic restenosis. • Late loss was invariably focal, and was observed exclusively inside the stent in Taxus stents, whereas there was significant edge effect observed with Cypher stents. • Diabetes and lesion length >20 mm appear to be predisposing factors.