The paclitaxel-eluting stent in percutaneous coronary intervention: Part II. Comparison with the sirolimus-eluting stent, economics, and unanswered questions

Cardiology in Review
Gretchen M RayWilliam H Frishman

Abstract

The paclitaxel- and sirolimus-eluting stents are currently the only drug-eluting stents approved for use in the United States. These 2 stents differ in terms of mechanism of drug action, the construct of the stent itself, and the drug delivery polymer. Clinical trials have demonstrated superiority of both paclitaxel- and sirolimus-eluting stents when compared with bare-metal stents in terms of reducing restenosis and the need for target vessel revascularization. Recently published head-to-head trials have not conclusively shown 1 drug-eluting stent to be superior to the other, but have demonstrated more favorable angiographic results with the sirolimus-eluting stent compared with the paclitaxel-eluting stent; however, no significant difference has been demonstrated in clinical outcomes such as myocardial infarction or death. In terms of economics, the paclitaxel-eluting stent is substantially more expensive than the bare-metal stent. However, by significantly reducing the risk of restenosis and need for repeat revascularization, the higher direct cost of the paclitaxel-eluting stent may in theory be offset by lower overall healthcare costs, although economic analyses have yet to definitively establish that the paclitaxel-elutin...Continue Reading

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