Clinical and Angiographic Outcomes After Treatment of De Novo Coronary Stenoses With a Novel Platinum Chromium Thin-Strut Stent

• Published in: Journal of the American College of Cardiology 2010-07, Vol.56 (4), p.264-271
• Main Authors: Kereiakes, Dean J., MD, Cannon, Louis A., MD, Feldman, Robert L., MD, Popma, Jeffrey J., MD, Magorien, Raymond, MD, Whitbourn, Robert, MBBS, Dauber, Ira M., MD, Rabinowitz, Abram C., MD, Ball, Michael W., MD, Bertolet, Barry, MD, Kabour, Ameer, MD, Foster, Michael C., MD, Wang, John C., MD, Underwood, Paul, MD, Dawkins, Keith D., MD
• Format: Article
• Language: English
• Subjects: Cardiovascular; chromium; drug-eluting stent; Internal Medicine; paclitaxel; platinum; restenosis
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2010.04.011

Objectives The aim of this study was to evaluate the safety and efficacy of the novel platinum chromium TAXUS Element paclitaxel-eluting stent (PES) compared with the TAXUS Express PES (Boston Scientific, Natick, Massachusetts) in treating coronary artery stenoses. Background The TAXUS Element is a novel thin-strut (81 μm), platinum chromium alloy PES designed to improve radial strength, radiopacity, and deliverability, while safely providing comparable restenosis benefit compared with a previous-generation PES. Methods The PERSEUS (Prospective Evaluation in a Randomized Trial of the Safety and Efficacy of the Use of the TAXUS Element Paclitaxel-Eluting Coronary Stent System) Workhorse (WH) trial is a prospective, randomized (3:1), controlled, multicenter study of the TAXUS Element (vs. TAXUS Express) PES for the treatment of de novo coronary atherosclerotic lesions ≤28 mm in length in reference vessels ≥2.75 to ≤4.0 mm in diameter. The primary end point was the 12-month rate of target lesion failure, and the secondary end point was 9-month angiographic in-segment percentage diameter stenosis. The study was powered to demonstrate noninferiority to TAXUS Express for both end points. Results The intent-to-treat analysis included 1,262 patients (320 TAXUS Express, 942 TAXUS Element). The TAXUS Element was noninferior to TAXUS Express with respect to both the incidence of target lesion failure (5.57% vs. 6.14%, respectively; difference: 0.57%; 95% credible interval: 1.85%; Bayesian posterior probability of noninferiority = 0.9996) and percentage diameter stenosis (ln[%DS] 3.09 vs. 3.12, respectively; difference: 0.03; 95% credible interval: 0.11; Bayesian posterior probability of noninferiority = 0.9970). No differences in clinical outcomes to 12 months were observed between stent treatments, and stent thrombosis was infrequent (0.3% Express, 0.4% Element). Conclusions At 1 year, the TAXUS Element is comparable in efficacy to the TAXUS Express PES. Furthermore, no safety concerns related to the novel platinum chromium alloy or stent design were observed. (A Prospective Evaluation in a Randomized Trial of the Safety and Efficacy of the Use of the TAXUS Element Paclitaxel-Eluting Coronary Stent System for the Treatment of De Novo Coronary Artery Lesions; NCT00484315 )