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EES lowered long-term adverse events vs. ZES in STEMI
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Results from a prospective registry study concluded that everolimus-eluting stents are more efficacious than zotarolimus-eluting stents for STEMI, and using a second-generation stent combined with upfront glycoprotein IIb/IIIa inhibitors appears to be safe.
Researchers compared the long-term performance of everolimus-eluting stents (EES; Promus, Boston Scientific; n=412) and Endeavor zotarolimus-eluting stents (E-ZES; Medtronic; n=519) in STEMI in 931 consecutive patients. Glycoprotein IIb/IIIa inhibitors upfront were included in the protocol.
Mortality outcomes were similar for the median follow-up duration of 2.4 years (interquartile range, 1.6-3.1). The composite endpoint of cardiac death, target vessel-related MI and target lesion revascularization was 9.7% for EES vs. 13.7% for E-ZES (HR=0.64; 95% CI, 0.42- 0.99). This was primarily driven by reduced TLR rates of 3.4% for EES vs. 7.3% for E-ZES (HR=0.46; 95% CI, 0.23-0.92). Definite stent thrombosis rates were low and similar between groups (1.1% in EES vs. 1.9% in E-ZES; P=.19).
All-cause mortality, MI, repeat revascularization and cardiac mortality did not differ during long-term follow-up. There were comparable rates of stent thrombosis (ST). ST occurred subacutely (24 hours to 30 days after PCI) in six cases, once in EES and five times in E-ZES. Late ST (30 days to 1 year after PCI) occurred in two E-ZES patients, and very late ST (later than 1 year) occurred in two EES patients and one E-ZES patient.
“MI has long been considered an off-label indication for DES,” the researchers wrote. “While first-generation DES have been shown to reduce revascularization rates in STEMI patients compared to BMS, the benefit is offset by a higher risk of very late ST.”
Disclosure: The researchers report no relevant financial disclosures.
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