Does prosthesis–patient mismatch affect outcome of aortic valve replacement?

  • Rebecca Ireland
  • Published 2006 in Nature Clinical Practice Cardiovascular Medicine

Abstract

In patients with ischemic heart disease, percutaneous coronary implantation of antiproliferative-drug-eluting stents reduces the rate of restenosis compared with intervention with bare-metal stents. At present, paclitaxel and sirolimus are the only FDA-approved drugs for use in drug-eluting stents, but the relative efficacy of these agents in preventing restenosis in small coronary vessels is not known. The aim of the prospective randomized study by Mehilli et al. was to investigate whether paclitaxel-eluting stents were noninferior to sirolimus-eluting stents in terms of in-stent late luminal loss in 360 patients with de novo small coronary vessels (diameter <2.8 mm). Angiographic data, however—available for 313 patients—failed to show such a result. Patients treated with paclitaxel-eluting stents (n = 154, 174 lesions) experienced greater in-stent luminal loss than those treated with sirolimuseluting stents (n = 159, 176 lesions, + 0.32 mm; P <0.001). Restenosis was observed in 33 lesions treated with paclitaxel-eluting stents and in only 20 lesions treated with sirolimuseluting stents (P = 0.047); this difference was greatest in the smallest vessels (<2.24 mm). Paclitaxel-eluting stents were also inferior in terms of the number of target lesion revascularization procedures required (revascularization performed in 30 of 204 lesions vs 13 of 198 in the sirolimus group; P = 0.008). The results show that, in patients with lesions in small coronary arteries, sirolimus-eluting stents are superior to paclitaxel-eluting stents in terms of in-stent late luminal loss, the occurrence of angiographic restenosis and the need for revascularization. Kate Matthews

DOI: 10.1038/ncpcardio0489
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Cite this paper

@article{Ireland2006DoesPM, title={Does prosthesis–patient mismatch affect outcome of aortic valve replacement?}, author={Rebecca Ireland}, journal={Nature Clinical Practice Cardiovascular Medicine}, year={2006}, volume={3}, pages={236-236} }