Clinical Research
Interventional Cardiology
Long-Term Comparison of Everolimus-Eluting and Sirolimus-Eluting Stents for Coronary Revascularization

https://doi.org/10.1016/j.jacc.2011.01.023Get rights and content
Under an Elsevier user license
open archive

Objectives

This study sought to compare the unrestricted use of everolimus-eluting stents (EES) with sirolimus-eluting stents (SES) in patients undergoing percutaneous coronary intervention.

Background

It is unclear whether there are differences in safety and efficacy between EES and SES during long-term follow-up.

Methods

Using propensity score matching, clinical outcome was compared among 1,342 propensity score–matched pairs of patients treated with EES and SES. The primary outcome was a composite of death, MI, and target vessel revascularization.

Results

The median follow-up was 1.5 years with a maximum of 3 years. The primary outcome occurred in 14.9% of EES- and 18.0% of SES-treated patients up to 3 years (hazard ratio [HR]: 0.83, 95% confidence interval [CI]: 0.68 to 1.00, p = 0.056). All-cause mortality (6.0% vs. 6.5%, HR: 0.92, 95% CI: 0.68 to 1.25, p = 0.59) was similar, risks of myocardial infarction (MI) (3.3% vs. 5.0%, HR: 0.62, 95% CI: 0.42 to 0.92, p = 0.017), and target vessel revascularization (7.0% vs. 9.6%, HR: 0.75, 95% CI: 0.57 to 0.99, p = 0.039) were lower with EES than SES. Definite stent thrombosis (ST) (HR: 0.30, 95% CI: 0.12 to 0.75, p = 0.01) was less frequent among patients treated with EES. The reduced rate of MI with EES was explained in part by the lower risk of definite ST and the corresponding decrease in events associated with ST (HR: 0.25, 95% CI: 0.08 to 0.75, p = 0.013).

Conclusions

The unrestricted use of EES appears to be associated with improved clinical long-term outcome compared with SES. Differences in favor of EES are driven in part by a lower risk of MI associated with ST.

Key Words

coronary disease
drug-eluting stents
stent thrombosis

Abbreviations and Acronyms

CI
confidence interval
DES
drug-eluting stent(s)
EES
everolimus-eluting stent(s)
HR
hazard ratio
MI
myocardial infarction
PES
paclitaxel-eluting stent(s)
PS
propensity score
RR
relative risk
SES
sirolimus-eluting stent(s)
ST
stent thrombosis
TLR
target lesion revascularization
TVR
target vessel revascularization

Cited by (0)

The analysis was funded by intramural grants provided by CTU Bern, Bern University Hospital, the Institute of Social and Preventive Medicine, University of Bern, and the Swiss National Science Foundation (Grant 33CM30-124112). Dr. Räber is the recipient of a research fellowship (SPUM) funded by the Swiss National Science Foundation. Dr. Jüni is an unpaid steering committee member of Medtronic, Abbott Vascular, and Johnson & Johnson (clinical trials). Dr. Meier has received research grants from and served on the Speakers’ Bureaus of Abbott and Cordis. Prof. Windecker has received consulting and lecture fees from Abbott, Boston Scientific, Biosensors, Cordis, and Medtronic. All other authors have reported that they have no relationships to disclose. Drs. Räber and Jüni contributed equally to this work.