SPIRIT Analysis Compares Xience V and Taxus DES for Treating Small Vessel CAD

July 1, 2010—In Catheterization and Cardiovascular Interventions, Antonio L. Bartorelli, MD, et al on behalf of the SPIRIT II and SPIRIT III investigators published findings from a pooled analysis of the two trials to evaluate the safety and efficacy of the Xience V everolimus-eluting stent (EES) (Abbott Vascular, Santa Clara, CA) compared to the Taxus paclitaxel-eluting stent (PES) (Boston Scientific Corporation, Natick, MA) in small vessels. The investigators noted that the Xience V EES has been shown to improve angiographic and clinical outcomes after percutaneous myocardial revascularization, but its performance in small coronary arteries has not been investigated.

In this pooled analysis, the investigators studied a cohort of 541 patients with small coronary vessels (reference diameter < 2.765 mm) using patient and lesion level data from the SPIRIT II and SPIRIT III studies. Taxus Express (73% of lesions) and Taxus Liberté PES (27% of lesions) were used as controls in SPIRIT II. The Taxus Express² PES was the control in SPIRIT III.

The investigators reported that the mean angiographic in-stent and in-segment late loss were significantly less in the EES group compared with the PES group (0.15 ± 0.37 mm vs 0.3 ± 0.44 mm; P = .011 for in-stent; 0.1 ± 0.38 mm vs 0.21 ± 0.34 mm; P = .034 for in-segment). EES also resulted in a significant reduction in composite major adverse cardiac events at 1 year (19/366 [5.2%] vs 17/159 [10.7%]; P = .037) because of fewer non–Q-wave myocardial infarctions and target lesion revascularizations. At 1 year, the rate of non–Q-wave myocardial infarction was significantly lower in the EES group compared with that of the PES group (6/366 [1.6%] vs 8/159 [5%]; P = .037).

From this analysis, the investigators concluded that in patients with small vessel coronary arteries, the Xience V EES was superior to the Taxus PES.