ACC 2005 ANNUAL SESSION HIGHLIGHT
Interventional Cardiology
John S. Douglas, Jr, MD, FACC*
Interventional Cardiology, Emory University School of Medicine, and the Cardiac Catheterization Laboratory, Emory University Hospital, Atlanta, Georgia
* Reprint requests and correspondence: Dr. John S. Douglas, Jr., Emory University Hospital, 1364 Clifton Road, NE, Atlanta, Georgia 30322. (Email: john_douglas{at}emoryhealthcare.org).
Following the Food and Drug Administration (FDA) approval of the Cypher sirolimus-eluting stent (Cordis, Johnson & Johnson, Miami, Florida) in 2003, a dramatic increase occurred in the use of this device and the subsequently approved Taxus paclitaxel-eluting stent (Boston Scientific Corp., Natick, Massachusetts). By 2004, over 70% of patients who underwent implantation of a coronary stent in the National Heart, Lung, and Blood Institute Dynamic Registry received a drug-eluting stent (1). Among the Late-Breaking Clinical Trials in Interventional Cardiology presented at the 54th Annual Scientific Sessions of the American College of Cardiology (ACC) in Orlando, Florida, those reporting outcomes from drug-eluting stent trials captured the attention of attendees in a virtual drug-eluting stent parade. For the first time, head-to-head comparisons of the two FDA-approved stents were reported. Comparison of the use of sirolimus-eluting stents with coronary artery bypass grafting (CABG) and the results of a randomized comparison of a new sirolimus-type coating, ABT-578, with bare-metal stenting were reported. Use of the Taxus stent in high-risk lesions was compared to bare-metal stents (BMS) in a randomized trial. The first randomized trial testing the efficacy of the Cypher stent compared to BMS in saphenous vein grafts was also reported. These and other late-breaking trials produced one of the most interesting ACC Scientific Sessions in recent years.
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The SIRTAX trial
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The objective of SIRTAX trial was to compare the safety and efficacy of the sirolimus-eluting Cypher stent with the paclitaxel-eluting Taxus stent for percutaneous coronary revascularization in all comers in a randomized trial (2). One-thousand and twelve patients treated at University Hospitals, Bern and Zurich, Switzerland, were randomized. This study was conducted without industry support. Patients and outcome assessors were blinded. Patients with coronary artery diameter 2.25 to 4.0 mm were included with no limitation with respect to the number of lesions or vessels treated. The primary end point was a composite of cardiac death, myocardial infarction (MI), or ischemia-driven target vessel revascularization (TVR) at nine months. Secondary end points included target lesion revascularization (TLR), TVR, and in-segment late luminal loss (stent plus 5-mm borders) determined angiographically in a prespecified substudy of approximately 500 patients. Patient demographics, clinical presentation, and the extent of coronary disease were quite similar in both Cypher- and Taxus-treated patients. Almost one-quarter of each group had ST-segment elevation myocardial infarction (STEMI), a similar percentage had troponin-positive acute coronary syndromes, and about one-half had stable angina. Patient groups were well matched with respect to lesion characteristics, number of lesions, lesion length (approximately 19 mm), and procedural details. Device and lesion success was 99% in both groups. Dr. Stephan Windecker presented the primary end point of major adverse cardiac events (MACE) at nine months, which occurred in 6.2% of patients receiving a Cypher and 10.8% of patients treated with a Taxus stent (p = 0.009). Target lesion revascularization was the only component of the composite end point that was statistically different and it was lower in the Cypher-treated patients (4.8% vs. 8.3%, p = 0.02). Rates of death, cardiac death, and MI were not significantly different.
In the angiographic substudy of 527 patients with over 700 lesions, in-segment late loss was significantly lower in sirolimus-eluting stents compared to paclitaxel-eluting stents (0.19 mm vs. 0.32 mm, p = 0.001) and in-segment binary restenosis was lower (6.7% vs. 11.9%, p = 0.02). These investigators concluded that sirolimus-eluting stents were superior to paclitaxel-eluting stents in prevention of MACE in all comers at nine months owing primarily to a reduction in angiographic restenosis and need for TLR.
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The reality trial
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The second randomized trial comparing the two FDA-approved drug-eluting stents (DES) recruited 1,353 patients in 90 centers in Europe, Asia, and Latin America (3). The study was sponsored by Cordis, Johnson & Johnson. Patients included had lesions >50% in target vessels 2.75 to 3.0 mm in diameter. The first lesion length was required to be >15 mm and the second lesion >10 mm. Study patients had silent ischemia or stable or unstable angina. Patients with acute MI within 72 h, ostial lesions, unprotected left main, ejection fraction 
25%, total occlusions, and in-stent restenosis were excluded. The primary end point was in-lesion binary restenosis by quantitative coronary angiography at eight months. Patients in the Cypher and Taxus groups had similar baseline demographics. Approximately 28% were diabetic and 7% were insulin-dependent. Eighty-six percent in both groups had ACC/American Heart Association (AHA) B2/C lesions; the mean lesion length was 17 mm. There were no differences in procedural aspects; lesion success was achieved in 99% of patients. Over 90% of patients underwent angiographic follow-up at eight months, and clinical follow-up was obtained in over 95%.
According to Dr. Marie-Claude Morice, the primary end point—binary restenosis in-lesion—occurred in 9.6% of patients receiving Cypher and 11.1% in Taxus patients (p = 0.31). No significant difference existed in death, cardiac death, MI, TLR, or MACE rates at eight months. Angiographic parameters such as late loss favored Cypher; the in-stent late loss for Cypher was 0.09 mm versus 0.31 mm in the Taxus group (p < 0.001). Significantly more stent thromboses occurred in Taxus stents, 1.8% versus 0.4%, than in Cypher (p = 0.0196), and this represented the first study to show a difference in safety between DES. All stent thromboses occurred within 30 days of implantation. In contrast, only four stent thromboses were observed in over 1,500 patients enrolled in TAXUS-I, -II, -IV, and -V, a rate of approximately 0.3%. As was pointed out by Dr. Eberhard Grube, the scheduled discussant for this late breaking clinical trial, stent thrombosis was not a prespecified end point, and given the possibility of an alpha error, no conclusions should be drawn.
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The ISAR-diabetes trial
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This trial was a head-to-head comparison of Taxus versus Cypher stents in 250 diabetic patients randomized in two German centers (4). Funded by the German Heart Center, the trial’s primary end point was late lumen loss; secondary end points were angiographic restenosis and need for TLR during a nine-month follow-up period. The study was designed to show the non-inferiority of the Taxus stent compared to the Cypher stent (an in-segment late loss difference <0.16 mm would indicate non-inferiority). Approximately one-third of patients were insulin-dependent, and mean lesion length was about 13 mm. Angiographic follow-up was obtained in 82% of patients. Late lumen loss was 0.67 mm in Taxus patients and 0.43 mm in Cypher patients. The late loss difference of 0.24 failed to show non-inferiority of the paclitaxel stent. Dr. Adnan Kastrati stated that the superiority of the sirolimus stent was demonstrated at a p value of 0.002. Angiographic restenosis was observed in 16.5% of Taxus-treated patients and in 6.9% in Cypher patients (p = 0.03). Target lesion revascularization occurred in 12% of Taxus patients and 6.4% of subjects treated with Cypher (p = 0.13). There was no difference in the occurrence of death or MI between Cypher- and Taxus-treated subjects. The three studies cited thus far suggest that sirolimus-eluting stents have a more robust anti-proliferative effect, but significantly better outcomes in terms of clinical end points were reported only in the SIRTAX trial, and the difference was 3.5 TVRs per 100 patients treated.
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The TAXUS-V trial
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Conducted in 66 U.S. centers, this study was a randomized comparison of paclitaxel-eluting and bare-metal Express stents (Boston Scientific Corp.) in complex anatomy (5). Boston Scientific Corp. was the sponsor. The TAXUS-V study randomized 1,156 patients undergoing non-emergent stent implantation of single lesions 10 mm to 46 mm in length with reference vessel diameter 2.25 to 4.0 mm. Vessels were 2.5 mm in 39%; lesions were 
26 mm long in 26%; the mean stented segment was 28 mm. The primary end point, the rate of TVR for ischemia at nine months, occurred in 17.3% of BMS and 12.1% of Taxus stents (p = 0.018) according to Dr. Gregg Stone. Binary restenosis was present in 33.9% of controls and 18.9% of subjects treated with Taxus (p < 0.0001). There were no differences in death, MI, or stent thrombosis (0.7% vs. 0.7%) at nine months.
When the subgroup of patients treated with a 2.25-mm stent was analyzed, TLR was significantly lower with Taxus (10.4% vs. 21.5%, p = 0.03). The primary end point, TVR, was not significantly reduced (24.7% in bare-metal group versus 16.0% in Taxus, p = 0.16), but binary restenosis was significantly lower with Taxus (31.2% vs. 49.4%, p = 0.01). No differences existed in rates of stent thrombosis, death, MI, or MACE at nine months.
In the subgroup of 379 patients who received multiple stents, there was a higher rate of 30-day MACE in Taxus-treated patients compared to the bare-metal stent group (8.3% vs. 3.3%, p = 0.047). This was believed to be related to more side branch narrowing with Taxus stents (42.6% vs. 30.6%, p = 0.03) and more frequently diminished Thrombolysis In Myocardial Infarction (TIMI) flow when a Taxus stent was added compared to when an additional bare-metal stent was implanted (41.9% vs. 28.6%, p = 0.02). Whether this is related to the polymer producing thicker stent struts is uncertain. At nine months, no differences were seen in rates of death, cardiac death, or stent thrombosis, however, a marked reduction occurred in TVR (29.8% vs. 16.2%, p = 0.002) and binary restenosis (57.8% vs. 27.2%, p < 0.0001) with the use of Taxus stents.
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The arterial revascularization therapies study (ARTS)-II
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The ARTS-I trial was a randomized, multi-center, European study conducted in 1997 and 1998 in which 1,205 multivessel disease patients were randomized to either CABG or bare-metal stent implantation. At one year in the ARTS-I trial, there was no difference in death, stroke, or MI, but there were 17% more revascularizations and $2,973 less cost with bare-metal stenting. The ARTS-II trial was a single arm, 45-center, European study in which 607 multivessel disease patients received 3.7 sirolimus-eluting stents per patient and outcomes were compared to the ARTS-I trial (6). The main goal of the ARTS-II trial was to demonstrate non-inferiority in clinical effectiveness and cost effectiveness of the sirolimus-eluting stent compared to the ARTS-I trial. The study was supported by Cordis, Johnson and Johnson. The primary end point of the ARTS-II trial was the effectiveness of multivessel disease Cypher stenting compared to the ARTS-I-CABG trial group measured as freedom from major adverse cardiac and cerebrovascular events (MACCE) at one year. In the ARTS-II trial, MAACE at one year was 10.4% compared to 11.6% in the ARTS-I (CABG) trial and 26.5% in the ARTS-I (percutaneous coronary intervention [PCI]) trial. Because ARTS-II patients had significantly higher risk than the ARTS-I trial patients, reflected by more diabetes, triple vessel disease, and other high risk features, Dr. Patrick Serruys and colleagues used a Bayesian statistical approach to adjust for these differences. One-year MAACE adjusted by this analysis was 8.1% for the ARTS-II trial versus 13.1% for the ARTS-I (CABG) trial. Thus, despite a higher risk profile, the overall MAACE rates of the ARTS-II trial were lower than the ARTS-I (PCI) and ARTS-I (CABG) trials, and adjustment for baseline differences accentuated this finding. Further, the composite end point of death/cerebrovascular accident/MI was significantly lower for the ARTS-II trial compared to the ARTS-I (CABG) trial (p < 0.001). Re-intervention in the ARTS-I CABG trial at one year was significantly lower than the ARTS-II trial (4.1% vs. 8.5%, p = 0.003). Although this was not a randomized trial, the very favorable outcome of sirolimus-treated multivessel disease patients was reassuring and supported use of this strategy for similar multivessel disease patients who are suitable for drug-eluting stent implantation.
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The ENDEAVOR-II trial
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This was a randomized, double-blind, 72-center international trial comparing the safety and efficacy of the ABT-578–coated Driver cobalt-alloy stent (Medtronic Vascular, Santa Rosa, California) with the Driver bare-metal stent in 1,197 patients who underwent stenting of a single de novo lesion (7). The trial was sponsored by Medtronic Vascular. Stent diameters were 2.25 to 3.5 mm and lesion length 14 to 27 mm. The primary end point was target vessel failure (cardiac death, MI, or TVR) at nine months. The initial 600 randomized patients were scheduled for angiographic follow-up at eight months.
Patient demographics and angiographic characteristics were not significantly different. Seventy-eight percent of patients had ACC/AHA B2/C lesions; the mean lesion length was 14 mm, and the mean reference vessel diameter was 2.75 mm. Lesion success was achieved in >99% of patients. The primary end point, namely target vessel failure, occurred in 8.1% of patients receiving the ABT-578–coated Endeavor stent (Medtronic Vascular) compared to 15.4% in patients receiving a bare-metal stent (p < 0.0005). The MACE at nine months was significantly lower in Endeavor-treated patients (7.4% vs. 14.7%, p < 0.0001). Target lesion revascularization occurred less frequently in Endeavor-treated patients (4.6% vs. 12.1%, p < 0.0001), but there was no difference in death or MI. Six-hundred patients underwent angiographic follow-up at eight months. In-segment binary restenosis was significantly lower with Endeavor (13.3% vs. 34.2%, p < 0.0001) as was late loss in-segment (0.36 mm vs. 0.71 mm, p < 0.0001) and late loss in-stent (0.62 mm vs. 1.03 mm, p < 0.0001). Stent thrombosis rates were low (0.5% for Endeavor) and there was no evidence of acquired malapposition. Dr. William Wijns noted the safety of Endeavor and its efficacy in substantially reducing clinical restenosis and MACE compared to the Driver bare-metal stent.
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Cypher versus BMS in saphenous vein grafts (SVG)
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The first randomized trial comparing Cypher versus BMS in de novo SVG lesions was reported by Vermeersch et al. (8) from Antwerp, Belgium. This was a prospective, randomized, single-center study. The primary end point was late loss in-stent and in-segment at six-month follow-up angiography. Secondary end points were binary restenosis and clinical events. Vessel diameter was 2.5 to 4.5 mm. Patients with creatinine >3 mg/dl, those with total occlusions, requirement for more than two stents, prior brachytherapy in the target vessel, or prior stent within 5 mm of the target lesion were excluded. Distal protection was strongly recommended and was utilized in 80% of patients. Seventy-five subjects were randomized either to Cypher or BMS. The mean graft age was 13.5 years. Patient demographics and lesion and graft location were similar in the two treatment groups. Lesion success was 100%. The primary end point, late loss, was significantly lower in Cypher-treated patients, both in-stent (0.43 mm vs. 0.93 mm, p < 0.0005) and in-segment (0.46 mm vs. 0.93 mm, p < 0.0005). Binary restenosis occurred in 5% of Cypher-treated patients and in 37% of patients receiving BMS (p = 0.0005). Of 42 Cypher stents implanted, there were two restenoses and no total occlusions compared to 15 restenoses and two total occlusions among 43 BMS. The MACE at six months occurred in 16% of Cypher patients and in 27% of patients treated with BMS. The investigators concluded that the use of Cypher in SVGs appeared to be safe and effective in reducing late loss and binary restenosis.
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DES in small vessels
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Long-term outcomes following sirolimus-eluting stenting of vessels <2.7 mm in diameter were reported for almost 1,000 patients gleaned from six multi-center trials by Leon et al. (9). Compared to small vessel lesions treated with BMS, angiographic and clinical outcomes at eight to nine months were superior with Cypher for late loss (0.21 mm vs. 0.81 mm, p < 0.0001), restenosis (6.9% vs. 39.8%, p < 0.0001), TLR (3.5% vs. 17.1%, p < 0.0001), and MACE (6.4% vs. 19.4%, p < 0.0001). Stent thrombosis in sirolimus stent-treated patients occurred in 0.8% of cases, a rate not significantly different from controls.
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Unprotected left main stenting
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The use of DES in the treatment of unprotected left main coronary disease received mixed reviews at the ACC 2005 Scientific Sessions. The Asian Multicenter Registry in a prospective analysis of 138 patients reported that sirolimus and paclitaxel stents were equally effective, yielding restenosis rates of 3% or less, and TVR and MACE in only 1.5% of cases at 12 months (10). Results from the Scripps Clinic, however, suggested a cautious approach was warranted. In 51 patients treated with Cypher stents, there were two in-hospital acute stent thromboses and one cardiac death at five months; restenosis occurred in 30% of patients (11). Restenosis most often occurred at the circumflex ostium and was frequently silent. In patients requiring repeat PCI, a significant rate of re-restenosis was encountered. The investigators recommended that the use of sirolimus-eluting stents in unprotected left main coronary disease be reserved for selected patients with mandated angiographic follow-up, preferably at three and nine months.
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Bifurcations
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Mixed reactions were also reported with use of DES in bifurcations. Among 178 patients treated with the crush technique, Ge et al. (12) reported stent thrombosis in 2.8% and MACE in 18% at six months . Outcomes were similar for sirolimus- and paclitaxel-eluting stents. Using a more conservative approach of stenting the main branch and provisional stenting of the side branch in 82 patients, Lefevre et al. (13) noted no stent thromboses, and TVR occurred in only 2.5% of patients at seven months.
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Chronic total occlusions (CTO)
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Although there has been no randomized, controlled trial of DES in CTO, favorable outcome data from observational studies reported at the ACC 2005 Scientific Sessions suggest improved efficacy compared to BMS. In 415 CTO patients from the e-Cypher registry, six-month MACE was 3.3% and TLR was 1.4% (14). In a prospective analysis of 380 patients with CTOs, in a multicenter Asian registry, restenosis was reported in <2% and MACE in 2.3% of cases (15). The rate of angiographic restudy was not stated. Outcomes with Cypher and Taxus were not significantly different. The combination of new wiring techniques to improve the initial success of CTO PCI (16) and DES to suppress intimal proliferation and restenosis provides an exciting and improved opportunity to palliate patients with CTOs and in many cases avoid the need for surgical revascularization.
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Acute MI
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Percutaneous intervention with stent implantation has become the preferred treatment for STEMI, especially in high-risk patients. Although a randomized trial of DES in STEMI has not been performed, most of the reports of their use for this indication from the ACC 2005 Scientific Sessions suggested that they are safe and effective. Among 312 consecutive STEMI patients reported from a single center, 51% received a sirolimus-eluting stent and the remainder a bare metal stent (17). At six months, there were no stent thromboses in patients receiving Cypher stents and outcomes were better with respect to repeat intervention (1.4% vs. 7.8%, p = 0.005), reinfarction (0.6% vs. 4.1%, p = 0.05), and MACE (3.4% vs. 16.3%, p = 0.0001). In 216 STEMI patients treated at four Italian centers, 30-day outcomes were similar with Cypher and Taxus, with mortality at 2% and 3%, respectively, and stent thrombosis in 1% and 2% of cases, respectively (18). However, in the e-Cypher registry among 171 patients who received 1 Cypher stent within 24 h of infarction, stent thrombosis occurrence in 4.7% and TLR was higher at six months compared to patients without acute MI (8.2% vs. 1.8%, p < 0.001) (19). A carefully conducted prospective trial of DES in STEMI is needed.
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In-stent restenosis
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Although intravascular brachytherapy has been shown to be safe and effective in preventing subsequent restenosis, reports from the ACC 2005 Scientific Sessions suggest that DES are the preferred strategy. Among 133 patients treated with brachytherapy at a single center, one-third eventually required re-intervention for failed brachytherapy (20). Iofina et al. (21) in an observational trial of 124 patients reported restenosis in 11% of subjects treated with Cypher stents and in 30% following brachytherapy. Among 142 patients receiving Cypher stents for in-stent restenosis in the e-Cypher registry, TLR was required in 15%; however, stent thrombosis occurred in 3.5% of cases (22). In an Asian multicenter registry (23), the outcome of 260 patients treated with DES was favorable for Cypher and Taxus (12-month TVR was 7.4% and 13.4%, respectively).
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The BARRICADE trial
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This randomized prospective study tested the safety and efficacy of polytetrafluoroethylene (PTFE)-covered stents compared to BMS in SVGs (24). The primary end point was angiographic restenosis at eight months. This report of the first 243 patients randomized revealed balanced baseline characteristics and similar 30-day outcomes. However, at nine months the outcomes were poorer for patients receiving the PTFE-covered stent with respect to MACE (33% vs. 21%, p = 0.047). Angiographic restenosis occurred in 32.5% of PTFE-covered stents compared to 25.6% of BMS (p = 0.39) and there was a trend toward more total occlusions (20.3% vs. 10.5%, p = 0.09). On the basis of these results, the trial was terminated. This PTFE-covered stent remains available for treatment of coronary artery perforations and can be lifesaving for this indication.
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Conclusions
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The ACC 2005 Scientific Sessions provided new insights into the safety and effectiveness of DES. For the first time, head-to-head comparisons of the two FDA-approved products were reported. The striking effectiveness of DES was affirmed in multiple but not in all anatomic subsets. The future of interventional cardiology has never been brighter, and DES are leading the parade.
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References
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- Cohen HA, Williams DO, Holmes DR, et al. Use of drug-eluting stents in contemporary interventiona comparison of bare metal stent use in the National Heart, Lung, and Blood Institute Dynamic Registry. (abstr) J Am Coll Cardiol 2005;45(Suppl A):63A.
- Windecker S, Remondino A, Eberli F, et al. A randomized comparison of a sirolimus with a paclitaxel eluting stent for coronary revascularization: the SIRTAX Trial. Late Breaking Clinical Trial. 2005Presented at: the American College of Cardiology 54th Annual Meeting; Orlando, Florida; March.
- Morice MC, REALITY Investigators REALITY: A prospective, randomized, multi-center comparison study of the Cypher sirolimus-eluting and Taxus paclitaxel-eluting stent systems. Late Breaking Clinical Trial. 2005Presented at: the American College of Cardiology 54th Annual Meeting; Orlando, Florida; March.
- Kastrati A, Dibra A, Mehilli J, et al. Paclitaxel-eluting stent versus sirolimus-eluting stent for the prevention of restenosis in diabetic patients with coronary artery disease. Late Breaking Clinical Trial. 2005Presented at: the American College of Cardiology 54th Annual Meeting; Orlando, Florida; March.
- Stone GW, Ellis SG, Cannon L, et al. Outcomes of the polymer-based, paclitaxel-eluting Taxus stent in complex lesions: principal clinical and angiographic results from the Taxus-V pivotal randomized trial. Late Breaking Clinical Trial. 2005Presented at: the American College of Cardiology 54th Annual Meeting; Orlando, Florida; March.
- Serruys PW, ARTS-II Investigators ARTS-II: Arterial Revascularization Therapies Study Part II of the sirolimus-eluting stent in the treatment of patients with multivessel de novo coronary artery lesions. Late Breaking Clinical Trial. 2005Presented at: the American College of Cardiology 54th Annual Meeting; Orlando, Florida; March.
- Wijns W, Fajadet J, Kuntz RE. A randomized comparison of the Endeavor ABT-578 drug eluting stent with a bare metal stent for coronary revascularization: results of the ENDEAVOR-II Trial. Late Breaking Clinical Trial. 2005Presented at: the American College of Cardiology 54th Annual Meeting; Orlando, Florida; March.
- Vermeersch P, Van Langenhove G, Convens C, et al. First randomized trial comparing sirolimus-eluting stents versus bare metal stents in severely diseased saphenous vein graft treatmentsix month clinical and angiographic outcome. (abstr) J Am Coll Cardiol 2005;45(Suppl A):84A.
- Leon MB, Mehran R, Popma J, et al. Long-term results after sirolimus-eluting stent in small vessel lesionsan integrated analysis of six multicenter trials. (abstr) J Am Coll Cardiol 2005;45(Suppl A):64A.
- Nakamura S, Muthusamy T, Bae JH, et al. Comparison of efficacy and safety between sirolimus-eluting stent (Cypher) and paclitaxel-eluting stent (Taxus) in unprotected left main coronary arteriesMulticenter Registry in Asia. (abstr) J Am Coll Cardiol 2005;45(Suppl A):85A.
- Price MJ, Sawhney N, Cristra E, et al. Unprotected left main coronary artery revascularization with sirolimus-eluting stentsthree and nine month follow-up. (abstr) J Am Coll Cardiol 2005;45(Suppl A):53A.
- Ge L, Lakovou I, Tsagalou E, et al. Thrombosis after drug-eluting stent implantation in bifurcation lesions by crush stent technique(abstr) J Am Coll Cardiol 2005;45(Suppl A):65A.
- Lefevre T, Louvard Y, Dumas P, et al. Evaluation of sirolimus-eluting stents for the treatment of bifurcation lesionsa real world study. (abstr) J Am Coll Cardiol 2005;45(Suppl A):56A.
- Lotan C, Gershlick A, Guagliumi G, et al. Treatment of chronic total occlusion with the sirolimus-eluting stent—results from the e-Cypher Registry(abstr) J Am Coll Cardiol 2005;45(Suppl A):47A.
- Nakamura S, Muthusamy TS, Bae JH, et al. Comparison of efficacy and safety between sirolimus-eluting stent (Cypher) and paclitaxel-eluting stent (TAXUS) on the outcomes of patients with chronic total occlusionsMulticenter Registry in Asia. (abstr) J Am Coll Cardiol 2005;45(Suppl A):48A.
- Hirano K, Muramatsu T, Tsukahara R, et al. Does revascularization using the new wiring technique of chronic total occlusion (CTO) contribute to improve the long-term prognosis?(abstr) J Am Coll Cardiol 2005;45(Suppl A):62A.
- Newell M, Sigakis C, Larson DM, et al. Sirolimus-eluting stents are safe and effective for acute and long-term management of ST-segment elevation myocardial infarction in the "real world"(abstr) J Am Coll Cardiol 2005;45(Suppl A):24A.[CrossRef]
- Falchetti E, Vittori G, Signorini U, et al. Comparing Cypher versus Taxus in patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary interventiona sub-analysis from the Real-world Eluting-stent Comparative Italian Retrospective Evaluation (RECIPE) study. (abstr) J Am Coll Cardiol 2005;45(Suppl A):84A.
- Katz S, Costa MA, Berger PB, et al. The CYPHER U.S. Post Market Surveillance Registry (e-Cypher)—six month results in acute myocardial infarction patients(abstr) J Am Coll Cardiol 2005;45(Suppl A):84A.
- Gruberg L, Suleiman M, Petchersky S, et al. Five year intracoronary radiation for the prevention of in-stent restenosisnot as hot as we thought. (abstr) J Am Coll Cardiol 2005;45(Suppl A):41A.
- Iofina E, Skurzewski P, Radke P, et al. Superior acute and follow-up results of sirolimus-eluting stents compared to vascular brachytherapy for in-stent restenosis(abstr) J Am Coll Cardiol 2005;45(Suppl A):83A.
- Alameddine FF, Costa M, Katz S, et al. CYPHER sirolimus-eluting Bx Velocity stent is safe and effective for the treatment of in-stent restenosis(abstr) J Am Coll Cardiol 2005;45(Suppl A):44A.
- Nakamura S, Muthusamy TS, Bae JH, et al. Comparison of efficacy and safety between sirolimus-eluting stent (Cypher) and paclitaxel-eluting stent (Taxus) on the outcome of patients with diffuse in-stent restenosismulticenter registry in Asia. (abstr) J Am Coll Cardiol 2005;45(Suppl A):83A.
- Stone GW, Goldberg S, Mehran R, et al. A prospective, randomized U.S. trial of the PTFE covered JOSTENT for the treatment of diseased saphenous vein grafts: the BARRICADE trial(abstr) J Am Coll Cardiol 2005;45(Suppl A):27A.
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The SIRTAX trial
The reality trial