Five-Year Data From COMPARE Trial Published

July 24, 2015—Pieter C. Smits, MD, et al reported the 5-year follow-up data from the COMPARE trial of everolimus-eluting stents (EES; Xience V, Abbott Vascular) and paclitaxel-eluting stents (PES; Taxus Liberté, Boston Scientific Corporation) in an all-comers population undergoing percutaneous coronary intervention (PCI). The study is available online ahead of print in the Journal of the American College of Cardiology (JACC): Cardiovascular Interventions.

According to the investigators, the medium-term 1- and 2-year results of the prospective randomized controlled COMPARE trial showed superior clinical outcomes with EES compared with PES in an all-comers PCI population. Whether this benefit is sustained over longer-term follow-up is unknown. Systematic, long-term follow-up data on these metallic drug-eluting stents with durable polymers are scarce, noted the investigators.

As summarized in JACC: Cardiovascular Interventions, the trial enrolled 1,800 patients undergoing PCI who were randomly assigned to EES or PES. Five-year follow-up was completed in 1,791 (99.5%) patients. The prespecified composite primary endpoint was death, myocardial infarction (MI), or target vessel revascularization (TVR).

The investigators found that treatment with EES compared with PES led to a relative risk reduction of the primary endpoint by 27% (18.4% vs 25.1%) driven by lower rates of MI (7% vs 11.5%) and TVR (7.4% vs 11.4%), but not with mortality (9% vs 10.3%; relative risk 0.88). Moreover, patients treated with EES compared with PES had lower rates of definite/probable stent thrombosis at 5 years (3.1% vs 5.9%). The hazard curves for TVR, MI, and stent thrombosis diverge over the first 3 years and, subsequently, progress in parallel.

The early- and medium-term superiority of EES over PES measured both by safety and efficacy endpoints is sustained at 5 years in this all-comer population, concluded the investigators in JACC: Cardiovascular Interventions. The investigators also noted that these findings show an ongoing device-related event rate, indicating the need for new stent or resorbable scaffold technology to further improve outcome of patients with coronary artery disease treated with PCI.