Drug-eluting coronary stents – focus on improved patient outcomes

Figures & data

Figure 1 The response to stent implantation.

Reprinted from J Am Coll Cardiol, Vol. 56, Garg and Serruys, Coronary stents: current status, pp. S1–S42, Copyright (2010), with permission from Elsevier.⁹⁸

Figure 2 Coronary stents. (A) Taxus^® stent (Boston Scientific Corporation, Natick, MA) with stainless steel metallic platform; (B) Xience V^® Everolimus Eluting Coronary Stent (Abbott Laboratories, Abbott Park, IL) with cobalt chromium platform.

© 2011 Boston Scientific Corporation or its affiliates. All rights reserved. Used with permission of Boston Scientific Corporation. Reproduced with permission of Abbott Laboratories.

Figure 3 A cross-section through a stent strut.¹¹⁷

Table 1 Specifications of the Food and Drug Administration-approved drug-eluting stents

Stent	Drug (μm)	Polymer	Polymer thickness (μm)	Release kinetics 28 days	Metal	Strut thickness (μm)
Cypher^® Stent (Cordis Corporation, Minneapolis, MN)	Sirolimus (140)	Polyethylene co-vinyl acetate and poly-n-butyl methacrylate	12.6	80%	SS	140
Taxus^® Express^2® Coronary Stent System (Boston Scientific Corporation, Natick, MA)	Paclitaxel (100)	Poly (styrene-b-isobutylene-b-styrene)	16.0	<10%	SS	132
Taxus^® Liberté^® Paclitaxel-Eluting Coronary Stent System (Boston Scientific Corporation)	Paclitaxel (100)	Poly (styrene-b-isobutylene-b-styrene)	16.0	<10%	SS	97
Endeavor^® Sprint Zotarolimus-Eluting Coronary Stent System (Medtronic, Inc)	Zotarolimus (100)	Phosphorylcholine	4.1	95%	CoCr	91
Xience V^® Everolimus Eluting Coronary Stent (Abbott Laboratories, Abbott Park, IL)	Everolimus (100)	Polyvinylidene fluoride co-hexafluoropropylene and poly-n-butly methacrylate	7.6	80%	CoCr	81

Note: Reprinted from J Am Coll Cardiol, Vol. 56, Garg and Serruys, Coronary stents: current status, pp. S1–S42, Copyright (2010), with permission from Elsevier.

Abbreviations: SS, stainless steel; CoCr, cobalt chromium.

Figure 4 Results of the Sirolimus-Eluting Stent in De Novo Native Coronary Lesions (SIRIUS) trial showing sirolimus-eluting stent (SES) vs base metal stent (BMS) at 12-month and 60-month follow-up.^30,118

Table 2 Results of PRImary Stenting of totally Occluded Native coronary arteries II (PRISON II) trial¹¹⁹

	SES	BMS	P value
Binary in-stent restenosis	7%	36%	P < 0.001
In-segment restenosis	11%	41%	P < 0.0001
Target lesion revascularization	4%	19%	P < 0.001

Abbreviations: BMS, bare metal stent; SES, sirolimus-eluting stent.

Figure 5 Results of the Endeavor II Clinical Trial: The Medtronic Endeavor Drug Eluting Coronary Stent System in Coronary Artery Lesions showing zotarolimus-eluting stent (ZES) versus bare metal stent (BMS) at (A) 9-month follow-up and (B) 60-month follow-up.^76,77

Abbreviations: ISR, in-stent restenosis; MACE, major adverse cardiovascular events; TLR, target lesion revascularization; TVF, target vessel failure.

Table 3 Academic Research Consortium definitions of stent thrombosis¹¹⁶

Category	Definition
Definite ST	Angiographic or pathologic confirmation of partial or total thrombotic occlusion within the peristent region AND at least ONE of the following, additional criteria: – Acute ischemic symptoms – Ischemic electrocardiogram changes – Elevated cardiac biomarkers
Probable ST	Any unexplained death within 30 days of stent implantation Any myocardial infarction, which is related to documented acute ischemia in the territory of the implanted stent without angiographic confirmation of stent thrombosis and in the absence of any other obvious cause
Possible ST	Any unexplained death beyond 30 days

Abbreviation: ST, stent thrombosis.

Figure 6 (A) Relative rates of stent thrombosis in drug-eluting stent (DES) and bare metal stent (BMS) from three large meta-analyses. (B) Overall mortality in DES and BMS.^94,95,97

Table 4 First and second generation drug-eluting stents (DES)

First generation DES	Second generation DES
Sirolimus-eluting stents   Cypher^® Stent (Medtronic, Inc, Minneapolis, MN)	Zotarolimus-eluting stents   Endeavor^®
Paclitaxel-eluting stents Taxus^®	Everolimus-eluting stents   Xience V^® Everolimus Eluting Coronary Stent (Abbott Laboratories, Abbott Park, IL)   Promus^® Everolimus-Eluting Coronary Stent System (Boston Scientific Corporation, Natick, MA)

Figure 7 Freedom from angina in trials comparing medical therapy to percutaneous coronary intervention (PCI).

Abbreviations: ACME, Angioplasty Compared to Medicine trial; RITA-2, Second Randomized Intervention Treatment of Angina trial; COURAGE, Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation trial; BARI-2D, Bypass Angioplasty Revascularization Investigation 2 Diabetes trial; MASS, Medicine, Angioplasty, or Surgery Study.

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