Second-Generation Drug-Eluting Stents: Moving the Field Forward
Can we already consider second-generation drug-eluting stents (DES) qualitatively superior to first-generation DES?
The COMPARE and SPIRIT IV trials represent the largest and more recent efforts to compare everolimus-eluting stents (EES) with paclitaxel-eluting stents (PES) in clinical practice. Both were high-quality, large randomized clinical trials with a superiority design powered to detect differences in hard clinical endpoints and with a prespecified, long-term clinical follow-up. Despite differences in trial design, considerable perspective can be gained by lumping together the results of both trials with previous data, and consistent and robust results emerge in favor of EES with reduced risk of stent thrombosis and target lesion revascularization. High methodological standards similar to those employed in COMPARE and SPIRIT IV should be maintained in future studies to ensure a critical, comprehensive, and exhaustive appraisal of DES long-term results. Finally, the superiority of EES over PES should not necessarily be construed as superiority of all second-generation DES over all first-generation DES.
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