Long-term clinical and economic analysis of the Endeavor drug-eluting stent versus the Driver bare-metal stent: 4-year results from the ENDEAVOR II trial (Randomized Controlled Trial to Evaluate the Safety and Efficacy of the Medtronic AVE ABT-578 Eluting Driver Coronary Stent in De Novo Native Coronary Artery Lesions).

Abstract

OBJECTIVES:

This study was designed to evaluate long-term clinical and economic outcomes for subjects receiving Endeavor drug-eluting versus Driver bare-metal stents (both Medtronic CardioVascular, Santa Rosa, California).

BACKGROUND:

Early studies found that the drug-eluting stent (DES) was a clinically and economically attractive alternative to the bare-metal stent; however, associations between DES and very late stent thrombosis suggest that longer follow-up is required.

METHODS:

We used clinical, resource use and follow-up data from 1,197 subjects randomized to receive Endeavor (n = 598) versus Driver (n = 599) stents in ENDEAVOR II (Randomized Controlled Trial to Evaluate the Safety and Efficacy of the Medtronic AVE ABT-578 Eluting Driver Coronary Stent in De Novo Native Coronary Artery Lesions) study with Medicare cost weights and quality of life adjustments applied from secondary sources. We compared differences through 4-year follow-up (1,440 days).

RESULTS:

Patients in both treatment groups had similar baseline characteristics. The use of Endeavor versus Driver reduced 4-year target vessel revascularization rates per 100 subjects (10.4 vs. 21.5; difference: -11.1; 95% confidence interval [CI]: -16.0 to -6.1; p < 0.001), with no difference in the rates per 100 subjects of death (5.0 vs. 5.2; difference: -0.2; 95% CI: -2.7 to 2.4; p = 0.90) or nonfatal myocardial infarction (3.2 vs. 4.4; difference: -1.2; 95% CI: -3.4 to 1.0; p = 0.29). After discounting at a 3% annual rate, there were no differences in quality-adjusted survival days (1,093 vs. 1,090; difference: 3; 95% CI: -13 to 19; p = 0.69) and total medical costs ($21,483 vs. $21,680; difference: -$198; 95% CI: -$1,608 to $1,207; p = 0.78).

CONCLUSIONS:

The use of Endeavor versus Driver was associated with a significant reduction in target vessel revascularization through 4-year follow-up with no difference in death, nonfatal myocardial infarction, quality-adjusted survival, or total medical costs. These results are comparable to those for other studies evaluating drug-eluting versus bare-metal stents. (Randomized Controlled Trial to Evaluate the Safety and Efficacy of the Medtronic AVE ABT-578 Eluting Driver Coronary Stent in De Novo Native Coronary Artery Lesions [ENDEAVOR II]; NCT00614848).

• Authors: Eric L Eisenstein, William Wijns, Jean Fajadet, Laura Mauri, Rex Edwards, Patricia A Cowper, David F Kong, Kevin J Anstrom
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 2 Issue 12 Pg. 1178-87 (Dec 2009) ISSN: 1876-7605 [Electronic] United States
• PMID: 20129543 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Metals
• Platelet Aggregation Inhibitors

Topics

• Aged
• Angioplasty, Balloon, Coronary (adverse effects, economics, instrumentation, mortality)
• Coronary Artery Disease (economics, mortality, therapy)
• Cost Savings
• Cost-Benefit Analysis
• Drug Therapy, Combination
• Drug-Eluting Stents (economics)
• Female
• Health Care Costs
• Hospitalization (economics)
• Humans
• Length of Stay (economics)
• Male
• Medicare (economics)
• Metals
• Middle Aged
• Models, Economic
• Myocardial Infarction (economics, etiology)
• Platelet Aggregation Inhibitors (therapeutic use)
• Prosthesis Design
• Quality of Life
• Stents (economics)
• Time Factors
• Treatment Outcome
• United States