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A new randomised study suggests that drug-eluting stents outperform bare-metal stents in percutaneous coronary intervention (PCI).
The study sought to determine whether tirofiban could achieve at least 50% of the anticipated effect of abciximab on the recovery of ST-segment-elevation myocardial infarction (STEMI). Results from 364 patients who were randomised to abciximab, and 368 patients to tirofiban, showed that high-dose tirofiban is just as effective as catheter lab standard abciximab and has fewer side-effects.
An earlier trial comparing the two treatments found abciximab to be superior. Lead researcher, Dr Marco Valgimigli, of Azienda Opedaliera Universitaria di Ferrara, Italy, believed, however, that tirofiban was under dosed, and set out to test whether the results would hold at proper dosing.
One hundred and eighty-four patients from each group received sirolimus-eluting stents.
Researchers observed a significantly lower rate of major adverse cardiac events at eight months in patients assigned to sirolimus-eluting stent as compared with uncoated stent (7.8% against 14.5%). This finding was driven by a 69% reduction in the need for a repeat procedure to reopen the treated coronary artery (3.2% with sirolimus-eluting stents against 10.2% with bare-metal).
They found, however, no differences between the two stent groups in the overall mortality rate, the composite incidences of death or reinfarction, or the cumulative incidence of stent thrombosis.
The results were reported at the Society for Cardiovascular Angiography and Interventions’ Annual Scientific Sessions, Chicago, and published simultaneously in The Journal of the American Medical Association (JAMA).