Saturday, June 02, 2012


I have often been asked what is the best DES? That is a moving target. At one time, the obvious answer was the Cypher stent. That was in 2007 when there were two main players. As we now know, Cypher stent has been withdrawn from the marketplace by Johnson & Johnson Cordis. Also, between 2007 and now we have also experience the Barcelona DES storm, which claimed that DES were killing our patients, that Interventionist who implanted these stents were murderers putting time bombs into patients.
Well we rode over those storms. Now till 2011 ( we only have review data till then ), which is the best DES?
Well Dr Sripal Bangalore and colleagues from the New York Uni School of Medicine, went into the internet, to search the data base ( it is cheaper that way ), to review 76 randomised controlled trial with 117,762 patient years of follow-up. Each trial must have enrolled more then 100 patients and they must have at least 6 months follow-up. The average follow-up for the combine cohort was 2.1years. There were 6 stents studied. The control stent was of course a bare metal stent. The other 5 DES were, the SES ( Cypher ), the PES ( Taxus ), the EES ( Xience V ), the ZES ( older version - endeavor ) and ZES ( newer version Resolute ). They reviewed the medical literature till March 2012.Their findings were published in the May 23rd issue of Circulation.
They found that overall, DES reduced restenosis by 40-60% when compared to BMS. Of the 5 DES, the EES ( Xience V ) performed the best in terms of efficacy, as well as stent thrombosis rates ( Xience V had  the lowest rates. This was followed by SES. The worse performing in this cohort was the PES and older version ZES. All of them however were better than BMS in terms of restenosis, and they were no worse than BMS in terms of stent thrombosis ( hopefully that will put an end to the Barcelona storm of 2008 ). In fact, the EES stent had a lower stent thrombosis rate than BMS.
Well, although that is what Dr Bangalore and colleagues have found out, it is important to note that this is a meta-analysis, where many things are not matched. Also, the length of follow-up is average 2.1 year ( a bit short from the DES stand point ). Whether there was any author bias in choosing which study to include, I do not know. It is true that many other new DES were not included like the Biomatrix / Nobori ( Biosensor International )stent using BES,and the Platinum Element ( Boston Scientific ) using EES on a different platform.
As I said at the beginning, it is an evolving field and the target is always moving.
Which is the best DES? Well, by 2011, it looks like Xience V, but by next year, who knows?

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