COMPARISONS OF ONE-YEAR CLINICAL OUTCOMES OF EVEROLIMUS- VERSUS SIROLIMUS- VERSUS PACLITAXEL-ELUTING STENTS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

• Kang-Yin Chen, 
• Seung-Woon Rha, 
• Yong-Jian Li, 
• Guang-Ping Li, 
• Amro Elnagar, 
• Byoung Geol Choi, 
• Sung il Im, 
• Sunwon Kim, 
• Jin Oh Na, 
• Seongwoo Han, 
• Cheol Ung Choi, 
• Hong Euy Lim, 
• Jin Won Kim, 
• Eung Ju Kim,
• Hong-Seog Seo, 
• Chang Gyu Park, 
• Dong Joo Oh, 
• Myung Ho Jeong

• Korea University Guro Hospital, Seoul, South Korea, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China

Background

The advantages of everolimus-eluting stents (EES) over paclitaxel-eluting stents (PES) have been established recently. However, less has been known about the advantages of EES over sirolimus-eluting stents (SES). Furthermore, the superiority of EES in the setting of acute myocardial infarction (AMI) remains unclear.

Methods

A total of 4175 AMI patients enrolled in Korea Acute Myocardial Infarction Registry (KAMIR) who received PES (n=1210), SES (n=1264), or EES (n=1701) were included. The composite clinical outcomes at 1 year were compared among the 3 groups. Target lesion failure (TLF) was defined as the composite of cardiac death, target lesion recurrent nonfatal myocardial infarction (Re-MI), or target lesion revascularization (TLR).

Results

The 3 groups had similar baseline clinical and procedural characteristics. The clinical outcomes at 1 year showed that compared to PES, SES had significantly lower incidences of TLR [1.8% vs 3.1%, P=0.034; adjusted odds ratio (OR) 0.55, 95% confidence interval (CI) 0.32-0.93, P=0.027] and TLF (7.9% vs 10.2%, P=0.043; adjusted OR 0.70, 95% CI 0.52-0.94, P=0.020). Compared to PES, EES showed significantly lower incidences of Re-MI (1.4% vs 2.7%, P=0.008; adjusted OR 0.44, 95% CI 0.24-0.79, P=0.006), TLR (1.2% vs 3.1%, p<0.001; adjusted OR 0.34, 95% CI 0.19-0.62, p<0.001), TLF (6.1% vs 10.2%, p<0.001; adjusted OR 0.59, 95% CI 0.44-0.79, p<0.001), and stent thrombosis (0.4% vs 1.8%, p<0.001; adjusted OR 0.12, 95% CI 0.04-0.37, p<0.001). The comparisons between SES and EES revealed that although EES had significantly lower incidences of stent thrombosis (0.4% vs 1.1%, P=0.013) and TLF (6.1% vs 7.9%, P=0.048) as compared with SES in univariable analyses, the differences were no longer significant after multivariable Cox regression analyses.

Conclusions

EES and SES had similar safety and efficacy profiles in the setting of AMI. However, both EES and SES seem to be superior to PES in reducing target lesion failure.

Copyright © 2012 Published by Elsevier Inc. All rights reserved.

http://www.sciencedirect.com/science/article/pii/S0735109712600473