In this trial, more than 1100 patients with angina pectoris were randomized to one of two different drug eluting stents (Resolute with zotarolimus versus Xience V with everolimus) and followed up for two years. The good news was a very low rate of very late stent thrombosis (0,3%). The number of patients needing an intervention for a stent problem (restenosis, stent thrombosis) was approximately 11% with no difference in the two groups. When looking at patient outcome, up to 20% of patients in both groups (no difference between groups) had a recurrent cardiac problem.
The authors conclude : "The differences between stent-related and patient-related events can be regarded as more indicative of the patients’ underlying global disease, rather than related to the specific localised coronary obstruction treated with the study stents." The doubling of the number of patient problems as compared to stent problems shows that the extent of the underlying disease is at least as important for prognosis than the lesion in itself. According to Silber et al “optimisation of secondary prevention and overall medical management during long-term follow-up seems to be more important thanc the initial choice between advanced, new generation drug-eluting stents”.
Hopefully, it will now be less difficult to convince the interventional cardiologists to refer their patients to cardiac rehabilitation