FROM ACC 2009 : THE ZEST TRIAL

Even as the ACC 2009, Orlando draw to a close, we have indeed learn much. No, I do not think that there were any great revolutionary therapy come out, this time. But we did see more clinically relevant data, that should help clinicians practice. One of the last late breaking trial to be presented yesterday was the ZEST trial. This is essentially an interventional cardiology trial, carried out in Korea under Dr SJ Park of Asan Medical Center. The results were presented yesterday. It was a 2,600 patient trial, non-inferiority trial comparing the use of the first generation DES ( Cypher and Taxus ) and the second generation DES ( Endeavor ), over a 1 year follow-up. These stents were implanted in almost real-world patients with few exclusion criteria. The investigators were willing to use the DES in many cases which may have been considered " off-label " use in USA, bifurcations, calcified lesions, long lesions, small vessels,etc.
Well, the results ( in a nutshell ) showed that Endeavor was better than Taxus, in terms of repeat TLR and TVR, with a trend towards lesser death and MI. But Cypher was marginally better than Endeavor. In otherwords, in head-to-head comparison of the 3 DES, Cypher came out best, second was Endeavor and third was Taxus. This was in an Asian population with almost all-comers included in the trial. I have always felt that the -limus drug is a more suprior drug when compared to the paclitexal drug.
Well, congratulations to SJ for pulling off such a well executed trial.
In the meantime, even as the data was being presented in Orlando, we have also learned that the Endeavor DES has received Japan FDA approval. When I was at the Beijing meeting in mid-March, I also saw the 2 year data of the Endeavor Resolute DES and the results were good. Looks like Medtronic International is not staying still. They are continuing to innovate and improved upon an already good stent.
As you can see, the field of interventinal cardiology is never staying still. It is continually being improved upon, so that the patient continue to get better and better care. Albeit, the only downside is cost. I am please to note that Medtronic Malaysia tells me that the new Endeavor Resolute, will cost the same as the Endeavor stent. Good for my patients.