title: Comparison of zotarolimus-eluting stents with sirolimus- and paclitaxel-eluting stents for coronary revascularization: the ZEST (comparison of the efficacy and safety of zotarolimus-eluting stent with sirolimus-eluting and paclitaxel-eluting stent for coronary lesions) randomized trial.
abstract: OBJECTIVE
  The aim of this study was to evaluate the relative efficacy and safety of zotarolimus-eluting stents (ZES) in comparison with the established and widely used sirolimus- (SES) and paclitaxel-eluting stents (PES) in routine clinical practice.
  
  
  BACKGROUND
  Whether ZES might provide similar clinical and angiographic outcomes in a broad spectrum of patients compared with SES or PES is undetermined.
  
  
  METHODS
  We performed a single-blind, multicenter, prospectively randomized trial to compare ZES with SES and PES in 2,645 patients undergoing percutaneous coronary intervention. The primary end point was a composite of major adverse cardiac events (MACE) (death, myocardial infarction, and ischemia-driven target vessel revascularization) at 12 months. A noninferiority comparison (ZES vs. SES) and a superiority comparison (ZES vs. PES) were performed for the primary end point.
  
  
  RESULTS
  Baseline clinical and angiographic characteristics were similar in the 3 groups. At 12 months, the ZES group showed noninferior rates of MACE compared with the SES group (10.2% vs. 8.3%, p for noninferiority = 0.01, p for superiority = 0.17) and significantly fewer MACE than the PES group (10.2% vs. 14.1%, p for superiority = 0.01). The incidence of death or myocardial infarction was similar among the groups (ZES vs. SES vs. PES, 5.8% vs. 6.9% vs. 7.6%, respectively, p = 0.31). The incidence of stent thrombosis was significantly lower in the SES group (ZES vs. SES vs. PES, 0.7% vs. 0% vs. 0.8%, respectively, p = 0.02).
  
  
  CONCLUSIONS
  In this large-scale, practical randomized trial, the use of ZES resulted in similar rates of MACE compared with SES and in fewer MACE compared with PES at 12 months. (Comparison of the Efficacy and the Safety of Zotarolimus-Eluting Stent Versus Sirolimus-Eluting Stent and PacliTaxel-Eluting Stent for Coronary Lesions; NCT00418067).
authors.affiliation: Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Cheol-Whan
authors.initials: CW
authors.lastname: Lee
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.forename: In-Whan
authors.initials: IW
authors.lastname: Seong
authors.forename: Jae-Hwan
authors.initials: JH
authors.lastname: Lee
authors.forename: Seung-Jea
authors.initials: SJ
authors.lastname: Tahk
authors.forename: Myung-Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.forename: Sang-Sig
authors.initials: SS
authors.lastname: Cheong
authors.forename: Joo-Young
authors.initials: JY
authors.lastname: Yang
authors.forename: Do-Sun
authors.initials: DS
authors.lastname: Lim
authors.forename: Ki-Bae
authors.initials: KB
authors.lastname: Seung
authors.forename: Jei-Keon
authors.initials: JK
authors.lastname: Chae
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Hur
authors.forename: Sang-Gon
authors.initials: SG
authors.lastname: Lee
authors.forename: Junghan
authors.initials: J
authors.lastname: Yoon
authors.forename: Nae-Hee
authors.initials: NH
authors.lastname: Lee
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Choi
authors.forename: Hyun-Sook
authors.initials: HS
authors.lastname: Kim
authors.forename: Kee-Sik
authors.initials: KS
authors.lastname: Kim
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Taeg-Jong
authors.initials: TJ
authors.lastname: Hong
authors.forename: Hun-Sik
authors.initials: HS
authors.lastname: Park
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D023903:Coronary Restenosis / Q000209:etiology / Q000401:mortality; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000009:adverse effects / Q000295:instrumentation*; D017239:Paclitaxel / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D016037:Single-Blind Method; D020123:Sirolimus / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus