COMPARISONS OF EVEROLIMUS- AND 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

Although the superiority of the new generation drug-eluting stents (DES) everolimus-eluting stents (EES) compared to paclitaxel-eluting stents (PES) has been established in some randomized trials, the advantages of EES over PES in the setting of acute myocardial infarction (AMI) remains unclear.

Methods

A total of 2911 AMI patients who underwent percutaneous coronary intervention (PCI) with PES (n=1210), or EES (n=1701) were enrolled from Korea Acute Myocardial Infarction Registry (KAMIR). The composite clinical outcomes at 1 year were compared between the 2 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). Total major adverse cardiac events (MACE) included total death, Re-MI, and target vessel revascularization (TVR).

Results

The two groups had well matched baseline characteristics. The clinical outcomes at 1 year showed that the incidences of cardiac death and total death were comparable between the 2 groups. However, EES group had significantly lower incidences of Re-MI (1.4% vs 2.7%, P=0.008), TLR (1.2% vs 3.1%, p<0.001), TVR (1.6% vs 4.3%, p<0.001), TLF (6.1% vs 10.2%, p<0.001), total MACE (8.2% vs 13.4%, p<0.001), and stent thrombosis (0.4% vs 1.8%, p<0.001) as compared with PES group. After multivariable Cox regression adjusted for baseline confounders, the use of EES was still independently associated with lower incidences of Re-MI [odds ratio (OR) 0.44, 95% confidence interval (CI) 0.24-0.79, P=0.006], TLR (OR 0.34, 95% CI 0.19-0.62, p<0.001), TVR (OR 0.35, 95% CI 0.21-0.57, p<0.001), TLF (OR 0.59, 95% CI 0.44-0.79, p<0.001), total MACE (OR 0.59, 95% CI 0.46-0.76, p<0.001), and stent thrombosis (OR 0.12, 95% CI 0.04-0.37, p<0.001) as compared with PES.

Conclusions

Despite similar 1-year mortality, the present study suggests that the use of EES in AMI is superior to PES in reducing stent thrombosis and other major individual end points at 1 year.

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