Drug-Releasing Stent Better Than Uncoated Stent For Angioplasty

A study published early online in the journal JAMA
concludes that patients who received angioplasty after a heart attack
and who received stents that released the drug sirolimus were much less
likely to experience major adverse cardiac events in the following 8
months compared to those patients who received uncoated
stents. Marco Valgimigli, M.D., Ph.D., (Cardiovascular
Institute, University of Ferrara, Italy) and colleagues also found that
patients who received the anticoagulants abciximab and tirofiban had
similar outcomes for some cardiac measures within 90 minutes after the
angioplasty.



In order to reduce major adverse cardiac events (MACE) in patients who
undergo angioplasty or percutaneous coronary intervention (PCI) for
ST-segment elevation myocardial infarction (STEMI - a particular
electrocardiogram pattern that follows a heart attack), it is common
for physicians to implant an uncoated stent in the patient and infuse
with the anticoagulant abciximab. The researchers were interested in
testing if using tirofiban instead of abciximab could results in
similar benefits as well as clinical and economic benefits. When using
drug-releasing stents instead of uncoated stents, doctors are less
likely to continually open obstructed blood vessels after elective PCI.
However, drug-releasing stents are often not used due to questionable
efficacy results and other safety concerns.



Valgimigli and colleagues used a sample of 745 patients from Italy,
Spain and Argentina who had STEMI and were undergoing PCI. Between
October 2004 and April 2007, the researchers evaluated the effect of
high-dose tirofiban and sirolimus-releasing stents compared with
abciximab infusion and uncoated-stent implantation.



Results showed that 722 patients (97%) had interpretable
electrocardiograms. Among these, at least a 50% resolution of
ST-segment elevation 90 minutes after PCI was noted in 83.6% (302 of
361 patients) of patients in the abciximab group and 85.3% (308 of 361
patients) of patients in the tirofiban group. The researchers also
noted similar outcomes regarding ischemic and hemorrhagic outcomes in
the two groups.



MACE rates were analyzed 8 months after PCI. For those who received
tirofiban, 9.9% had MACE, and for those who received
abciximab, 12.4% had MACE. Patients who had uncoated stents
had a higher rate of MACE - 54 patients, or 14.5%. Patients who were
treated with the sirolimus-releasing stent had comparatively lower MACE
rate - 29 patients, or 7.8%. Patients who received the
sirolimus-releasing stent were also much less likely to require
revascularization (repeat procedure to unblock a blood vessel) - 10.2%
with the uncoated stent compared with 3.2% with sirolimus-releasing
stent.



The authors conclude: "In summary, our study provides evidence that in
a broad population of largely unselected patients undergoing PCI for
STEMI, tirofiban therapy is associated with a noninferior resolution
from ST-segment elevation at 90 minutes postintervention compared with
abciximab, and at 8-month follow-up, MACE are approximately halved by
sirolimus-eluting stent implantation compared with uncoated stents."



Comparison of Angioplasty With Infusion of Tirofiban or
Abciximab and With Implantation of Sirolimus-Eluting or Uncoated Stents
for Acute Myocardial Infarction: The MULTISTRATEGY Randomized Trial

Marco Valgimigli; Gianluca Campo; Gianfranco Percoco; Leonardo
Bolognese; Corrado Vassanelli; Salvatore Colangelo; Nicoletta de
Cesare; Alfredo E. Rodriguez; Maurizio Ferrario; Raul Moreno; Tommaso
Piva; Imad Sheiban; Giampaolo Pasquetto; Francesco Prati; Marco S.
Nazzaro; Giovanni Parrinello; Roberto Ferrari

JAMA (2008). 299 Vol. 15.

doi:10.1001/jama.299.15.joc80026

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Written by: Peter M Crosta