Comparison of six-year clinical outcome of sirolimus-and paclitaxel-eluting stents to bare-metal stents in patients with ST-segment elevation myocardial infarction: An analysis of the RESEARCH (Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital) and T-SEARCH (Taxus Stent Evaluated at Rotterdam Cardiology Hospital) registries
Background: Short-and long-term data showed that drug-eluting stents (DES) significantly decreased target vessel revascularization (TVR) and major adverse cardiac event (MACE) rates compared to bare-metal stents (BMS). However, conflicting long-term data remain for patients with ST-segment elevation myocardial infarction (STEMI). Objective: Our aim was to assess the 6-year clinical outcome of all patients undergoing primary percutaneous coronary intervention (PPCI) for a de novo lesion with exclusive use of BMS, sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES). Methods: Three PPCI cohorts (BMS ≤ 80; SES ≤ 92; PES ≤ 162) were systematically followed for the occurrence of MACE. Results: Very late stent thrombosis was more common after the implantation of SES as compared to PES or BMS (7.6, 0.6, and 0.0, respectively; p ≤ 0.001). Kaplan-Meier estimates indicate no statistically significant difference for mortality between the three stent types at 6 years (BMS ≤ 25; SES ≤ 15; PES ≤ 21; Log-rank p ≤ 0.2). After adjustment for differences in baseline characteristics, mortality, mortality/myocardial infarction (MI), and MACE rates were significantly lower for SES compared to BMS, but not for PES (aHR ≤ 0.41, 95 CI: 0.17-0.98; aHR ≤ 0.44, 95 CI: 0.21-0.96; aHR ≤ 0.35, 95 CI: 0.17-0.72, respectively). No differences were observed between the three stent types for TVR rates. Conclusion: Neither SES nor PES improved safety or efficacy as compared to BMS in a STEMI population at 6 years. After adjusting, the usage of SES resulted in a significant decrease in mortality, mortality/MI and MACE rates as compared to BMS, in contrast to the usage of PES. SES and PES have a similar effectiveness and safety profile, although very late stent thrombosis was more common with SES.
|Keywords||percutaneous coronary intervention, ST-segment elevation myocardial infarction, stents|
|Journal||Journal of Invasive Cardiology|
Simsek, C, Magro, M, Boersma, H, Onuma, Y, Nauta, S.T, Daemen, J, … Serruys, P.W.J.C. (2011). Comparison of six-year clinical outcome of sirolimus-and paclitaxel-eluting stents to bare-metal stents in patients with ST-segment elevation myocardial infarction: An analysis of the RESEARCH (Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital) and T-SEARCH (Taxus Stent Evaluated at Rotterdam Cardiology Hospital) registries. Journal of Invasive Cardiology, 23(8), 336–341. Retrieved from http://hdl.handle.net/1765/84861