ONE-YEAR OUTCOMES AFTER THE UNRESTRICTED USE OF SIROLIMUS- VERSUS PACLITAXEL-ELUTING STENTS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

• Yong-Jian Li, 
• Seung-Woon Rha, 
• Kang-Yin Chen, 
• Qun Dang, 
• 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, Tianjin Nankai Hospital, Tianjin, People's Republic of China

Background

The safety and efficacy of the unrestricted use of sirolimus-eluting stents (SES) versus paclitaxel-eluting stents (PES) in the setting of acute myocardial infarction (AMI) still need further clarification in larger study population.

Methods

A total of 2474 AMI patients who underwent percutaneous coronary intervention (PCI) with SES (n=1264), or PES (n=1210) 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 similar baseline characteristics. The 1-year clinical outcomes showed that although the 2 group did not differ significantly in the incidences of cardiac death, total death, Re-MI, TVR, total MACE and stent thrombosis, SES group had significantly lower incidences of TLR (1.8% vs 3.1%, P=0.034) and TLF (7.9% vs 10.2%, P=0.043) as compared with PES group. Furthermore, SES group showed a trend toward significantly lower incidence of definite stent thrombosis (0.9% vs 1.7%, P=0.080) compared to PES group. Multivariable Cox regression analysis showed that compared to PES, SES was independently associated with lower incidences of TLR [odds ratio (OR) 0.55, 95% confidence interval (CI) 0.32-0.93, P=0.027] and TLF (OR 0.70, 95% CI 0.52-0.94, P=0.020) at one year. But SES failed to be an independent predictor of other adverse clinical outcomes.

Conclusions

Despite the similar incidences of cardiac death, total death, Re-MI, TVR, total MACE and stent thrombosis, SES seems to be superior to PES in reducing TLR and TLF in AMI patients at one year.

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