Researchers from the Netherlands have demonstrated that an everolimus-eluting stent (Xience V®; Abbott Vascular, Santa Clara, CA) is superior to a second-generation paclitaxel-eluting stent (Taxus Liberté®; Boston Scientific, Maple Grove, MN) in terms of both efficacy and safety.

“We believe that all drug-eluting stents (DES) are not equal, and that some DES perform better than others” says investigator Pieter Cornelis Smits. “We thought that this is more evident with the second-generation DES that are now available.” Smits and colleagues wanted to test their theory in an unselected patient population, representing 'real-world' practice. They enrolled 1,800 patients aged 18–85 years who were scheduled to undergo percutanous coronary intervention, irrespective of lesion size or location, or the number of vessels affected.

At 12 months follow-up, patients who received Xience V® stents had lower rates of the primary end point (a composite of death, myocardial infarction [MI], and target-vessel revascularization) than those with Taxus Liberté® stents. Although all-cause mortality did not differ between the two groups, the reduction in the rate of MI in the Xience V® group was evident after 30 days and persisted at 12 months. This effect on the rate of MI was driven by the lower incidence of early stent thrombosis in patients with the everolimus-eluting stent. The need for target-vessel revascularization was also reduced with Xience V® compared with Taxus Liberté®. The benefits of the Xience V® stent were less evident in patients with diabetes, who represented 18% of the study population, for reasons that are as yet unclear.

Dr Smits' group now plan to conduct a trial comparing Xience V® with a bioabsorbable polymer DES, to further investigate the impact of differences in stent composition on patient outcome.