An everolimus‐eluting stent versus a paclitaxel‐eluting stent in small vessel coronary artery disease: A pooled analysis from the SPIRIT II and SPIRIT III trials

Objectives: To evaluate the safety and efficacy of the XIENCE V everolimus‐eluting stent compared to the TAXUS paclitaxel‐eluting stent in small vessels. Backgroud: The XIENCE V everolimus‐eluting stent (EES) has been shown to improve angiographic and clinical outcomes after percutaneous myocardial revascularization, but its performance in small coronary arteries has not been investigated. Methods: In this pooled analysis, we studied a cohort of 541 patients with small coronary vessels (reference diameter <2.765 mm) by using patient and lesion level data from the SPIRIT II and SPIRIT III studies. TAXUS Express (73% of lesions) and TAXUS Liberté (27% of lesions) paclitaxel‐eluting stents (PES) were used as controls in SPIRIT II. In SPIRIT III, Taxus Express2 PES was the control. Results: Mean angiographic in‐stent and in‐segment late loss was significantly less in the EES group compared with the PES group, (0.15 ± 0.37 mm vs. 0.30 ± 0.44 mm; P = 0.011 for in‐stent; 0.10 ± 0.38 mm vs. 0.21 ± 0.34 mm; P = 0.034 for in‐segment). EES also resulted in a significant reduction in composite major adverse cardiac events at 1 year (19/366 [5.2%] vs. 17/159 [10.7%]; P = 0.037), due to fewer non‐Q‐wave myocardial infarctions and target lesion revascularizations. At 1 year, the rate of non‐Q‐wave myocardial infarction was significantly lower in the EES group compared with that of the PES group (6/366 [1.6%] vs. 8/159 [5.0%]; P = 0.037). Conclusions: In patients with small vessel coronary arteries, the XIENCE V EES was superior to the TAXUS PES. © 2010 Wiley‐Liss, Inc.