Drug-Eluting Stent Outperforms Bare Metal Says Study
October 22, 2007 - Implantation of the CYPHER Sirolimus-eluting Coronary Stent by Cordis Corp. used to treat completely blocked coronary arteries led to substantial reductions in recurrent blockage and the need for repeat treatment compared to bare metal stents in a study presented today at the Transcatheter Cardiovascular Therapeutics 2007 meeting (TCT 2007).
Researchers reported that the Approaches to Chronic Occlusions with Sirolimus-eluting Stents (ACROSS-CYPHER) study met its primary endpoint, which was the assessment of angiographic restenosis at six-month follow-up. Among 200 patients treated with the CYPHER Stent following successful reopening of a completely blocked coronary artery (chronic total occlusion), the likelihood of renarrowing of the treated segment (angiographic restenosis) was reduced by 65.6 percent compared with a pre-specified cohort of patients treated with a bare metal stent in the earlier Total Occlusion Study of Canada (TOSCA-1) trial. In the entire segment treated with balloon angioplasty and stents, the restenosis rate for the CYPHER Stent was 19.0 percent while the restenosis rate for the bare metal stent was 55.2 percent. Following risk adjustment, these differences translated into an 84 percent reduction in the primary endpoint (p<0.0001). Further, restenosis occurring only within the CYPHER Stent-treated area was 7.5 percent.
“Chronic total occlusions remain one of the most challenging lesions to treat, especially because rates of restenosis and reocclusion have remained high despite treatment with bare metal stents,” said David E. Kandzari, M.D., F.A.C.C., F.S.C.A.I., Chief Medical Officer, Cordis Corporation, who presented the results. “These data, combined with the results of the PRISON II Randomized Controlled Trial, which showed similar positive results for the CYPHER Stent in chronic total occlusions, add to the unsurpassed volume of clinical evidence on the use of the CYPHER Stent in a variety of patients and lesion subsets, including these very complex, chronically occluded vessels.”
Among patients treated with the CYPHER Stent, at six months, there were no deaths, and myocardial infarction and target lesion revascularization occurred in 1.0 percent and 6.0 percent of patients, respectively. Overall major adverse cardiac events were similarly low, at 6.5 percent.
The reported stent thrombosis rate for the CYPHER Stent was 0.0 percent within 24 hours after stent implantation, 0.0 percent between 1 and 30 days after stent implantation; and 0.5 percent beyond 30 days after stent implantation.
The ACROSS-CYPHER Trial is a prospective, multi-center, open-label, single-arm study designed to demonstrate the safety and efficacy of the CYPHER Stent in non-acute chronic total occlusions. The study included patients from 15 medical centers in the United States and Canada.
Dr. Kandzari is one of the principal investigators of the Cordis-sponsored study. Enrollment and six-month follow-up were completed before Dr. Kandzari joined Cordis. At the time, Dr. Kandzari was part of the faculty at Duke University Medical Center.
In the United States, the CYPHER Stent is indicated for de novo lesions less than 30 mm in length in native coronary arteries between 2.5 mm and 3.5 mm in diameter. It does not have an approved indication for patients with chronic total occlusions.
For more information: www.cypherstent.com