Review Shows DES Outperform BMS in Treating CTOs

February 9, 2011—The Society for Cardiovascular Angiography and Interventions (SCAI) announced that a systematic review of medical evidence has determined that drug-eluting stents (DES) outperform bare-metal stents (BMS) for revascularization of chronic total occlusions (CTOs) of coronary vessels. In the study, which was published in Catheterization and Cardiovascular Interventions, Bilal Saeed, MD, et al concluded that DES reduce restenosis, target lesion revascularization, and target vessel revascularization, offering a safe approach with similar adverse events compared to BMS (2011;77:315–332).

SCAI noted that medical evidence maintains that CTOs—with routinely low procedural success and high incidence of target vessel failure—represent the most challenging type of coronary lesion in interventional cardiology. Although specialized guidewires and advanced techniques have improved CTO angioplasty, high rates of restenosis and reocclusion remain a challenge.

To determine the performance of DES implantation in CTOs, the investigators performed a systematic review of medical literature published in online databases (PubMed, EMBASE, Cochrane Library) and cardiology societies' Web sites. The investigators found 17 published studies that reported outcomes for sirolimus- or paclitaxel-eluting stents and BMS implantation for coronary occlusions.

"Our findings confirm that treatment of total coronary occlusions with DES is associated with significant reductions in angiographic and clinical restenosis compared with BMS," commented Lead Investigator Emmanouil S. Brilakis, MD.

Analysis of angiographic outcomes in the studies revealed less restenosis with DES implantation compared to BMS (odds ratio, 0.15). At 6 to 12 months, target lesion revascularization and target vessel revascularization were also consistently lower among DES-treated patients (odds ratio, 0.13 and 0.18, respectively). In a 19-month follow-up period, the cumulative incidence of mortality, heart attack, or stent thrombosis was similar between DES and BMS in all studies.

Dr. Brilakis concluded, "The consistency and magnitude of treatment effect in the individual studies and meta-analysis establish DES as the standard therapy for CTO revascularization. Large, prospective trials that offer additional information on the role of DES in CTO and determine if second-generation DES could provide even more favorable outcomes are needed."

Three such studies are underway in the Netherlands, Spain, and the United States and will provide further medical evidence on the use of DES in treating CTOs, SCAI noted.