Early outcome after sirolimus-eluting stent implantation in patients with acute coronary syndromes: insights from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry.
OBJECTIVE
This study evaluated the early outcomes of patients with acute coronary syndromes (ACS) treated with sirolimus-eluting stents (SES).


BACKGROUND
The safety of SES implantation in patients with a high risk for early thrombotic complications is currently unknown.


METHODS
Sirolimus-eluting stents have been utilized as the device of choice for all percutaneous procedures in our institution, as part of the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. After four months of enrollment, 198 patients with ACS had been treated exclusively with SES (64% of those treated in the period) and were compared with a control group composed of 301 consecutive patients treated with bare stents in the same time period immediately before this study. The incidence of major adverse cardiac events (MACE) during the first month was evaluated (death, nonfatal myocardial infarction [MI], or re-intervention).


RESULTS
Compared with control patients, patients treated with SES had more primary angioplasty (95% vs. 77%; p < 0.01), more bifurcation stenting (13% vs. 5%; p < 0.01), less previous MI (28% vs. 45%; p < 0.01), and less glycoprotein IIb/IIIa inhibitor utilization (27% vs. 42%; p < 0.01). The 30-day MACE rate was similar between both groups (SES 6.1% vs. control patients 6.6%; p = 0.8), with most complications occurring during the first week. Stent thrombosis occurred in 0.5% of SES patients and in 1.7% of control patients (p = 0.4). In multivariate analysis, SES utilization did not influence the incidence of MACE (odds ratio 1.0 [95% confidence interval: 0.4 to 2.2]; p = 0.97).


CONCLUSIONS
Sirolimus-eluting stent implantation for patients with ACS is safe, with early outcomes comparable with bare metal stents.
Lemos
Pedro A
PA
Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Dr Molewaterplein 40, NL-3015 GD Rotterdam, the Netherlands.
Lee
Chi-hang
CH
Degertekin
Muzaffer
M
Saia
Francesco
F
Tanabe
Kengo
K
Arampatzis
Chourmouzios A
CA
Hoye
Angela
A
van Duuren
Marco
M
Sianos
Giorgios
G
Smits
Pieter C
PC
de Feyter
Pim
P
van der Giessen
Willem J
WJ
van Domburg
Ron T
RT
Serruys
Patrick W
PW
D000208:Acute Disease; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D012307:Risk Factors; D020123:Sirolimus / Q000627:therapeutic use*; D015607:Stents; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents; D020123:Sirolimus