Researchers have concluded that siromilus stents offer a lower heart attack risk for patients than bare metal stents or paclitaxel. Mortality risks linked to drug-eluting stents and bare-metal stents for coronary revascularization have generally been fairly similar, the researchers explain. You can read about their conclusions in a report in The Lancet, issued this week.

Dr Peter Juni, Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland, and team carried out an analysis of many prior studies combined (a meta-analysis), involving 38 trials and 18,023 patients. The follow-up period on these studies went up to four years. The researchers also received additional information on clinical outcomes from trialists and stent makers for 29 of the trials.

The study looked at three groups of patients - those who received..:

-- Siromilus-eluting stents
-- Bare-metal stents
-- Paclitaxel-eluting stents

Although mortality was similar in all the groups, siromilus-eluting stents were linked to a reduced heart attack risk, when compared to both bare-metal stents and paclitaxel-eluting stents.

Even though there were no major differences in the definite stent thrombosis risk, the risk of late definite stent thrombosis* was more than double for paclitaxel-eluting stents compared to bare-metal stents. The authors explain that as far as siromilus-eluting stents are concerned, no increase in the risk of late stent thrombosis was found (compared to bare-metal stents).

* (late definite stent thrombosis = one that occurs more than 30 days after implantation)

Both drug-eluting stents involved in this study offered patients a lower risk of target-lesion revascularization compared to bare-metal stents, said the writers. Siromilus-eluting stents reduced the risk by 70%, while paclitaxel-eluting stents reduced it by 58%. Siromilus-eluting stents reduced the risk by 30% compared to paclitaxel-eluting stents.

The authors wrote "We conclude, therefore, that siromilus-eluting stents seem to be clinically better than bare-metal and paclitaxel eluting-stents."

Dr. Mark Webster and Dr. John Ormiston, Auckland City Hospital, Auckland, New Zealand, in an accompanying comment discuss the merits of the various stent strategies and how this information might influence future treatment.

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