Sirolimus- or paclitaxel-eluting stents for coronary artery revascularisation

In coronary artery disease treatment, the rate of restenosis has been reduced by the introduction of sirolimus- and paclitaxel-eluting stents. Recently, two clinical trials have directly compared these stents. The first study enrolled 1012 patients with either stable angina, or an acute coronary syndrome with a stenotic lesion of >= 50% in a vessel. The primary end point was the composite of major adverse events by 9 months, and occurred in fewer patients with sirolimus than paclitaxel stents (6.2 and 10.8%, respectively), due to a lower rate of target-lesion revascularisation with sirolimus- than paclitaxel-eluting stents (4.8 and 8.3%, respectively). The second study enrolled 250 patients with diabetes, angina pectoris and/or a positive stress test, and clinically significant angiographic stenosis in a native coronary artery. The primary end point was in-segmental luminal loss on follow-up angiography, and showed a late luminal in-stent loss of 0.46 and 0.19 mm in the paclitaxel and sirolimus groups, representing 24 and 17% stenosis, and 14 and 5% restenosis, respectively. Therefore, evidence from recent clinical trials favours sirolimus- over paclitaxel-eluting stents.