Fan Bids Cypher, the Sirolimus-Eluting Coronary Stent, Adieu

Cypher will soon morph into cipher, and it’s not just about the why, but also the whence and the what once was and the what came next.

Cypher is, of course, the sirolimus drug-eluting stent (DES), the first, the original coronary DES, the one that burst onto the scene a decade ago and launched a new era in interventional cardiology. And soon it will be no more.

Dodo bird; courtesy Line 1; Wikimedia Commons

Earlier this week, Cypher’s manufacturer, Johnson & Johnson, announced that it would pull the stent off the market by the end of this year.   J&J cited “evolving market dynamics.” What they meant to say was that Cypher’s time has come and gone. I’ve recently written on this blog on how the second-generation coronary DES have set new efficacy standards for the field. Cypher had become a 10-year old dinosaur. Presumably the announced demise of the other first-generation DES, the paclitaxol-eluting Taxus stent, made by Boston Scientific, is just around the corner.

But I write not so much to bury Cypher as to celebrate it. In a dusty corner of my laptop, in a yellowed folder labeled ESC Stockholm 9/2001, sits the story I wrote almost a decade ago when French cardiologist  Marie-Claude Morice reported at the annual Congress of the European Society of Cardiology the primary, 7-month results from the first randomized, head-to-head comparison of a DES, Cypher, with a bare metal stent. The results from that 238-patient study showed a zero restenosis rate for the 120 patients who each received a single Cypher DES compared with a 26% restenosis rate in the control patients who received a bare metal stent. It was an electric moment.

“This is the start of a new era in treating coronary disease,”  I quoted Dr. Morice as saying. “We’ve never seen results like this before in interventional cardiology,” gushed Willem J. Van der Giessen, a cardiologist at the Thoraxcenter in Rotterdam, The Netherlands.

Like most heady, early days, reality soon arrived.  The more innocent era a decade ago was before most people thought about late stent thrombosis, before the idea of dual antiplatelet therapy existed. But few advances in medicine come without costs, and the truth is that DES were a sea change for cardiology and for medicine and Cypher was there first. And now it’s obsolete, which is good. That means there’s something better.

Here’s to you, Cypher.

—Mitchel Zoler (on Twitter@mitchelzoler)

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Filed under Cardiovascular Medicine, IMNG, Internal Medicine, Internal Medicine News, Practice Trends

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