Cardiophile MD

Carrid D and colleagues [A Multicenter Randomized Trial Comparing Amphilimus- With Paclitaxel-Eluting Stents in De Novo Native Coronary Artery Lesions. J Am Coll Cardiol, doi:10.1016/j.jacc.2011.12.009 (Published online 25 January 2012)] from Europe have compared polymer free amphilimus eluting stents with permanent polymer coated paclitaxel eluting stents in percutaneous coronary interventions of de novo lesions. The primary end point was angiographic late lumen loss at six months. One fifth of the patients had also undergone intravascular ultrasound (IVUS) evaluation. The duration of clinical follow up was five years. Among the three hundred and twenty odd patients studied, the clinical end points of cardiac death, myocardial infarction, target vessel revascularization (TLR) and stent thrombosis was similar between the two groups at one year. In stent late lumen loss was lower with amphilimus stent (0.14 ± 0.36 mm vs. 0.34 ± 0.40 mm, with p for both noninferiority and superiority <0.0001). The authors claim that the polymer free amphilimus stent has a significantly lower in stent late lumen loss and a trend towards better one year clinical safety and efficacy in the treatment of de novo coronary lesions. The stent technology is based on polymer free abluminal reservoir elution which avoids the exposure of the vessel wall to polymers present in the luminal side of conventional drug eluting stents which are potentially proinflammatory and may impair the healing of the vessel. The authors also claim that this feature may potentially reduce the need for prolonged dual anti platelet therapy with its attendant complications. We need more large scale randomized head to head comparisons of the various new generation coronary stents to get the final answer on which is the better of the lot.