Comparison of the efficacy and safety of zotarolimus-, sirolimus-, and paclitaxel-eluting stents in patients with ST-elevation myocardial infarction.
Drug-eluting stents (DESs) are increasingly used for treatment of acute ST-segment elevation myocardial infarction (STEMI), but there are few comparisons of outcomes of various types of DES. We compared the efficacy and safety of zotarolimus-eluting stents (ZESs), sirolimus-eluting stents (SESs), and paclitaxel-eluting stents (PESs) in primary intervention for STEMI. This multicenter, prospectively randomized ZEST-AMI trial included 328 patients at 12 medical centers who were randomly assigned to ZES (n = 108), SES (n = 110), or PES (n = 110) deployment. The primary end point was major adverse cardiac events (death, MI, and ischemia-driven target vessel revascularization) at 12 months. Secondary end points included the individual components of the primary end point, late loss, angiographic restenosis, and stent thrombosis. Baseline clinical and angiographic characteristics were well matched. In-segment late loss (0.28 +/- 0.42 vs 0.46 +/- 0.48 vs 0.47 +/- 0.50 mm, respectively, p = 0.029) and restenosis rate (2.7% vs 15.9% vs 12.3%, respectively, p = 0.027) at 8 months were lowest in the SES group compared to the ZES and PES groups. At 12 months, cumulative incidence rates of primary end points in the ZES, SES, and PES groups were 11.3%, 8.2%, and 8.2%, respectively (p = 0.834). There were 2 acute (in the SES group) and 5 subacute (2 in the SES group and 3 in the PES group) stent thromboses. Incidence of death, recurrent MI, or ischemia-driven target vessel revascularization did not differ among the 3 groups. In conclusion, despite the difference in restenosis rate, the efficacy and safety of the 3 different DESs showed similar, acceptable results in the treatment of STEMI.
Lee
Cheol Whan
CW
Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Park
Duk-Woo
DW
Lee
Seung-Hwan
SH
Kim
Young-Hak
YH
Hong
Myeong-Ki
MK
Kim
Jae-Joong
JJ
Park
Seong-Wook
SW
Yun
Sung-Cheol
SC
Seong
In-Whan
IW
Lee
Jae-Hwan
JH
Lee
Nae-Hee
NH
Cho
Yoon Haeng
YH
Cheong
Sang-Sig
SS
Lim
Do-Sun
DS
Yang
Joo-Young
JY
Lee
Sang-Gon
SG
Kim
Kee-Sik
KS
Yoon
Junghan
J
Jeong
Myung-Ho
MH
Seung
Ki Bae
KB
Hong
Taeg Jong
TJ
Park
Seung-Jung
SJ
D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D000077144:Clopidogrel; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000453:epidemiology; D003328:Coronary Thrombosis / Q000453:epidemiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy*; D009204:Myocardial Revascularization; D017239:Paclitaxel / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D002317:Cardiovascular Agents; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; C489443:zotarolimus; D013988:Ticlopidine; D017239:Paclitaxel; D001241:Aspirin; D020123:Sirolimus