Drug HighlightThe Paclitaxel-Eluting Stent in Percutaneous Coronary Intervention: Part II: Comparison With the Sirolimus-Eluting Stent, Economics, and Unanswered QuestionsRay, Gretchen M. PharmD*; Nawarskas, James J. PharmD*; Frishman, William H. MD†Author Information From the *University of New Mexico College of Pharmacy, Albuquerque, New Mexico; and the †Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, New York. Reprints: James J. Nawarskas, PharmD, BCPS, Associate Professor of Pharmacy, University of New Mexico, College of Pharmacy, MSC09 5360, 1 University of New Mexico, Albuquerque, NM 87131-0001. E-mail: JNawarskas@salud.unm.edu. Cardiology in Review: May-June 2006 - Volume 14 - Issue 3 - p 143-150 doi: 10.1097/01.crd.0000214683.72810.87 Buy Metrics Abstract The paclitaxel- and sirolimus-eluting stents are currently the only drug-eluting stents approved for use in the United States. These 2 stents differ in terms of mechanism of drug action, the construct of the stent itself, and the drug delivery polymer. Clinical trials have demonstrated superiority of both paclitaxel- and sirolimus-eluting stents when compared with bare-metal stents in terms of reducing restenosis and the need for target vessel revascularization. Recently published head-to-head trials have not conclusively shown 1 drug-eluting stent to be superior to the other, but have demonstrated more favorable angiographic results with the sirolimus-eluting stent compared with the paclitaxel-eluting stent; however, no significant difference has been demonstrated in clinical outcomes such as myocardial infarction or death. In terms of economics, the paclitaxel-eluting stent is substantially more expensive than the bare-metal stent. However, by significantly reducing the risk of restenosis and need for repeat revascularization, the higher direct cost of the paclitaxel-eluting stent may in theory be offset by lower overall healthcare costs, although economic analyses have yet to definitively establish that the paclitaxel-eluting stent is truly cost-effective. There is still much to be discovered regarding the paclitaxel-eluting stent, specifically the optimal stent design and drug release mechanism, the relative safety and efficacy of the paclitaxel-eluting stent compared with other drug-eluting stents, the long-term effects of the paclitaxel-eluting stent, the ideal antiplatelet regimen to use in patients with a paclitaxel-eluting stent, the safety and efficacy of the paclitaxel-eluting stent in various high-risk patient groups, and the ultimate cost-effectiveness of this device. © 2006 Lippincott Williams & Wilkins, Inc.