Four separate trials, all presented at the Transcatheter Cardiovascular Therapeutics (TCT) meeting in Washington DC, USA, showed impressive results with the new Xience V™ everolimus-eluting stent.
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The Xience™ stent was shown to be superior to the Taxus™ paclitaxel-eluting stent in two-year results from the COMPARE and SPIRIT IV trials (table 1). And Xience V™ showed similar outcomes to the Cypher™ sirolimus-eluting stent in the ISAR-TEST 4 and SORT-OUT 4 trials.
In the COMPARE trial, the everolimus-eluting stent was associated with reductions in the composite end point of death, non-fatal myocardial infarction (MI), and target vessel revascularisation compared with the Taxus Liberté™ stent.
And in the SPIRIT IV, the everolimus-eluting stent showed a significant reduction in the composite end point of cardiac death, target vessel MI, or ischaemia-driven target lesion revascularisation (TLR) compared with the older Taxus Express™stent.
Particularly notable in both the COMPARE and SPIRIT trials was a lower incidence of late stent thrombosis with the Xience™ stent, which has been a concern with both the Cypher™ and Taxus™ drug-eluting stents.
And this was achieved without all patients maintaining dual antiplatelet therapy throughout the study period. Whereas in SPIRIT IV, 72% of patients were still taking both clopidogrel and aspirin at two years, this applied to just 13% of patients in COMPARE. This observation has led to suggestions that the Xience™ stent might be a good option in patients who may find long-term clopidogrel problematic.