Propensity-Matched Patient-Level Comparison of the TAXUS Liberté and TAXUS Element (ION) Paclitaxel -Eluting Stents

• Published in: The American journal of cardiology Vol. 108; no. 6; pp. 828 - 837
• Main Authors: Kereiakes, Dean J., MD, Cannon, Louis A., MD, Ormiston, John A., MBChB, Turco, Mark A., MD, Mann, Tift, MD, Mishkel, Gregory J., MD, McGarry, Thomas, MD, Wang, Hong, MS, Underwood, Paul, MD, Dawkins, Keith D., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15-09-2011; Elsevier; Elsevier Limited
• Subjects: Alloys; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Chi-Square Distribution; Clinical outcomes; Clinical trials; Clinical Trials as Topic; Coronary Restenosis - prevention & control; Drug-Eluting Stents; Female; Heart attacks; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Myocardial Infarction - prevention & control; Paclitaxel - administration & dosage; Product design; Propensity Score; Prosthesis Design; Risk Assessment; Risk Factors; Stents; Treatment Outcome; Tubulin Modulators - administration & dosage; Human; Paclitaxel; Ions; Patient; Level; Circulatory system; Cardiology; Elements; Comparative study
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2011.05.011

Stent design, metal alloy composition, and strut thickness may influence late lumen loss and clinical outcomes after bare metal stent deployment; however, their impact on outcomes after drug-eluting stent deployment is unknown. Although the TAXUS Liberté and ION paclitaxel-eluting stents use similar polymer and drug, the ION stent incorporates a novel thin-strut platinum chromium metal alloy and cell design. We therefore compared patient-level data from 2,298 subjects enrolled into the TAXUS ATLAS (TAXUS Liberté) and PERSEUS (ION) clinical trials. Propensity-score (1:1) matching was performed to adjust for covariate imbalance between stent types. Twelve-month major adverse cardiac events were less frequent after use of the ION compared to the TAXUS Liberté (12.7% vs 8.3%, p <0.001, unadjusted; 12.0% vs 7.5%, p = 0.007, propensity matched) largely because of decreased non–Q-wave myocardial infarction (MI; 2.9% vs 1.4%, p = 0.01, unadjusted; 3.2% vs 0.9%, p = 0.004, propensity matched). The MI difference was predominantly periprocedural and in patients treated with a single stent. In conclusion, this exploratory post hoc analysis demonstrated that the ION was associated with fewer adverse clinical events than the TAXUS Liberté because of decreased non–Q-wave MI. Stent platform-related variables may influence clinical outcomes after drug-eluting stent use despite similar polymer and drug elution. Differences in adjunctive pharmacotherapy and/or stenting technique may also be contributory.