Abstract
Objective
To assess the safety and efficacy everolimus-eluting stents (EES) compared with first-generation drug-eluting stents (DES) in patients with acute myocardial infarction (MI) undergoing primary percutaneous coronary intervention (PCI).
Background
EES have been associated with improved clinical outcomes compared to paclitaxel-eluting stents (PES) and with similar outcomes compared to sirolimus-eluting stents (SES).
Methods
A total of 520 patients who presented with ST-elevation myocardial infarction (STEMI) from 2003 to 2013, who underwent primary PCI with DES, were retrospectively analyzed. Of these, 247 received SES, 136 PES, and 137 EES. Patients were followed up to 2 years for major adverse cardiac events (MACE). Univariate and multivariate models detected correlates to outcome.
Results
EES implantation, compared with PES and SES, resulted in comparable rates of MACE (8.8% vs. 16.2%, p = 0.06 and 8.8% vs. 12.6%, respectively, p = 0.26), stent thrombosis, MI, and target lesion revascularization. Patients who received EES had lower rates of all-cause mortality (3.7% vs. 12.6% vs. 9.4%, p = 0.03) at 1-year follow up. However, in the univariate and multivariate analyses, stent type was not independently associated with the primary outcome or with all-cause mortality. Diabetes mellitus and number of stents implanted were independently associated with the primary outcome.
Conclusion
While EES seem to be associated with better outcome when compared to PES, the main correlates of STEMI patients are the presence of diabetes and number of stents implanted, and not the type of stent used for intervention.
1
Introduction
Primary percutaneous coronary intervention (PCI) in patients presenting with ST-segment elevation myocardial infarction (STEMI) leads to significantly improved clinical outcomes compared with thrombolytic therapy . Meta-analyses of randomized trials showed similar safety and superior efficacy of 1st-generation drug-eluting stents (DES) over bare metal stents in primary PCI for STEMI, driven primarily by lower rates of target lesion revascularization (TLR) . Long-term studies have suggested that both 1st-generation DES achieve similar clinical outcomes . The XIENCE V everolimus-eluting stent (EES) (Abbott Vascular, Santa Clara, CA) was approved in the United States in 2008 after the Everolimus-Eluting Coronary Stent System in the Treatment of Patients with de novo Coronary Artery Lesions (SPIRIT) randomized trial series demonstrated its safety and efficacy compared with 1st-generation DES. Two prospective, randomized clinical trials have compared the XIENCE V stent with 1st-generation DES in primary PCI for patients presenting with acute myocardial infarction (MI) in a selected population. Xience V stent vs. Cypher stent in primary PCI for Acute Myocardial Infarction (XAMI) and the European Comparison of the Everolimus-eluting XIENCE V stent with the paclitaxel eluting TAXUS Liberté stent in all-comers: a randomized open label trial (COMPARE) trials evaluated EES vs. sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES), respectively. The present study assessed the long-term safety and efficacy of EES compared with the 1st-generation DES in patients who presented with STEMI.
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