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Outcomes after unrestricted use of everolimus-eluting stent compared to paclitaxel- and sirolimus-eluting stents.

Mahmoudi, M, Delhaye, C, Wakabayashi, K, Ben-Dor, I, Gonzalez, MA, Maluenda, G, Gaglia, MA, Torguson, R, Xue, Z, Suddath, WO , Satler, LF, Kent, KM, Pichard, AD and Waksman, R (2011) Outcomes after unrestricted use of everolimus-eluting stent compared to paclitaxel- and sirolimus-eluting stents. Am J Cardiol, 107 (12). pp. 1757-1762.

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Compared to paclitaxel-eluting stents (PESs) and sirolimus-eluting stents (SESs), a paucity of data exists regarding the clinical outcome of everolimus-eluting stents (EESs) in unselected patients with the entire spectrum of obstructive coronary artery disease. The present study cohort included 6,615 consecutive patients at Washington Hospital Center who underwent coronary artery stent implantation with EESs (n = 519), PESs (n = 2,036), or SESs (n = 4,060). Patients who received bare metal stents, zotarolimus-eluting stents, or 2 different drug-eluting stent types were excluded. The analyzed clinical end points were death, death or Q-wave myocardial infarction, target lesion revascularization (TLR), target vessel revascularization, definite stent thrombosis, and major adverse cardiac events, defined as the composite of death, Q-wave myocardial infarction, or TLR at 1 year. The groups were well matched for the conventional risk factors for coronary artery disease, except for systemic hypertension, which differed among the groups. The unadjusted end points for EESs and PESs were death (4.5% vs 7.1%; p = 0.03), TLR (3.4% vs 4.6%; p = 0.24), target vessel revascularization (5.6% vs 7.1%; p = 0.46), death or Q-wave myocardial infarction (4.5% vs 7.4%; p = 0.02), and definite stent thrombosis (0.0% vs 0.7%; p = 0.09). The unadjusted end points for EES and SES were death (4.5% vs 5.2%; p = 0.45), TLR (3.4% vs 5.8%; p = 0.3), target vessel revascularization (5.6% vs 8.6%; p = 0.05), death or Q-wave myocardial infarction (4.5% vs 5.4%; p = 0.39), and definite stent thrombosis (0.0% vs 1.08%; p = 0.003). The rates of major adverse cardiac events were similar among the 3 groups. After multivariate analysis, the rate of death or Q-wave myocardial infarction between the EES and PES groups was no longer significant (hazard ratio 1.14, 95% confidence interval 0.59 to 2.20, p = 0.70). In conclusion, the results of the present study suggest the use of EES in routine clinical practice is both safe and effective but offers no clinically relevant advantage in terms of hard end points compared to PES or SES.

Item Type: Article
Divisions : Surrey research (other units)
Authors :
Delhaye, C
Wakabayashi, K
Ben-Dor, I
Gonzalez, MA
Maluenda, G
Gaglia, MA
Torguson, R
Xue, Z
Suddath, WO
Satler, LF
Kent, KM
Pichard, AD
Waksman, R
Date : 15 June 2011
DOI : 10.1016/j.amjcard.2011.02.330
Uncontrolled Keywords : Aged, Coronary Artery Disease, Drug-Eluting Stents, Female, Humans, Immunosuppressive Agents, Male, Middle Aged, Myocardial Infarction, Paclitaxel, Sirolimus, Thrombosis, Treatment Outcome
Depositing User : Symplectic Elements
Date Deposited : 17 May 2017 09:47
Last Modified : 24 Jan 2020 17:38

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