NOT ALL DES ARE THE SAME. 3RD GENERATION DES ARE HERE AND BETTER.

The just concluded American College of Cardiology, annual scientific meeting, 2012 at Chicago, has just ended last week. At that meeting, Dr Robert Buryne of Munich Germany, presented a paper on the meta-analysis of 3 important DES trials using DES with bio-degradeable polymers and comparing with the good old cypher stent ( first generation DES ). The study arm were the patients from ISAR TEST 3, ISAR TEST 4, and the LEADERS, and the control arm was the Cypher stent. In ISAR TEST 3 and ISAR TEST 4, the Yukon Choice DES was used and in LEADERS, the Biomatrix DES was used. It was obvious that the biodegradable stents have less stent thrombosis, especially late stent thrombosis, and less TLR, out to 4 years.

Clinical outcomes through four years: ISAR-3, ISAR-4, and LEADERS

End point	Biodegradable polymer, n=2358 (%)	Durable polymer Cypher, n=1704 (%)	Hazard ratio (95% CI)
Death	9.3	10.0	0.90 (0.73-1.11)
Cardiac death	5.2	5.9	0.87 (0.66-1.15)
MI	6.0	6.8	0.96 (0.74-1.24)
Definite stent thrombosis	1.3	2.8	0.56 (0.35-0.90)
TLR	12.0	13.7	0.82 (0.68-0.98)
Cardiac death or MI	9.9	11.6	0.89 (0.73-1.09)
Cardiac death, MI, or TLR	19.0	21.6	0.85 (0.74-0.98)

There was a trend towards less cardiac death.
What we are waiting to see is a comparison of these biodegradable polymer DES with the second generation DES like Xience V and Endeavor Resolute. That should be very interesting. Cypher, though the standard bearer in the early DES years, is now no longer the standard bearer. It has been superceeded by the second generation, thin struts Xience V and Endeavor Resolute.
Of course in the background are all the work that has to do with bioabsorbable metal scaffolding stent. We will wait to see how all the numbers stack up and also the cost.