UNRESTRICTED USE OF EVEROLIMUS- VERSUS SIROLIMUS-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, 
• 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

Everolimus-eluting stent (EES) is currently one of the most commonly used second-generation drug-eluting stents in clinical practice. There is increasing interest in the comparison of EES versus the first generation DES sirolimus-eluting stent (SES), especially in patients with acute myocardial infarction (AMI).

Methods

A total of 2965 AMI patients who underwent percutaneous coronary intervention (PCI) with EES (n=1701), or SES (n=1264) were rerolled 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 similar baseline characteristics. The clinical outcomes at 1 year showed that although the 2 groups did not differ significantly in the incidences of cardiac death, Re-MI and TLR, EES group had significantly lower incidences of 1-year total death (5.9% vs 8.3%, P=0.012), TVR (1.6% vs 3.2%, P=0.006), TLF (6.1% vs 7.9%, P=0.048), total MACE (8.2% vs 12.6%, p<0.001) and stent thrombosis (0.4% vs 1.1%, P=0.013) as compared with SES group. However, after multivariable Cox regression adjusted for baseline confounders, the differences in total death [odds ratio (OR) 1.01, 95% confidence interval (CI) 0.76-1.36, P=0.927], TVR (OR 1.01, 95% CI 0.61-1.67, P=0.960), TLF (OR 1.14, 95% CI 0.85-1.53, P=0.393), total MACE (OR 0.99, 95% CI 0.78-1.26, P=0.944) and stent thrombosis (OR 0.81, 95% CI 0.27-2.43, P=0.712) were no longer significant.

Conclusions

The unrestricted use of EES and SES seems to have similar safety and efficacy profiles in the setting of AMI. Further randomized studies with larger study population are warranted to get definite conclusions.

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

http://www.sciencedirect.com/science/article/pii/S0735109712600321