title: Drug-eluting versus bare-metal stents in large coronary arteries.
abstract: BACKGROUND
  Recent data have suggested that patients with coronary disease in large arteries are at increased risk for late cardiac events after percutaneous intervention with first-generation drug-eluting stents, as compared with bare-metal stents. We sought to confirm this observation and to assess whether this increase in risk was also seen with second-generation drug-eluting stents.
  
  
  METHODS
  We randomly assigned 2314 patients needing stents that were 3.0 mm or more in diameter to receive sirolimus-eluting, everolimus-eluting, or bare-metal stents. The primary end point was the composite of death from cardiac causes or nonfatal myocardial infarction at 2 years. Late events (occurring during months 7 to 24) and target-vessel revascularization were the main secondary end points.
  
  
  RESULTS
  The rates of the primary end point were 2.6% among patients receiving sirolimus-eluting stents, 3.2% among those receiving everolimus-eluting stents, and 4.8% among those receiving bare-metal stents, with no significant differences between patients receiving either drug-eluting stent and those receiving bare-metal stents. There were also no significant between-group differences in the rate of late events or in the rate of death, myocardial infarction, or stent thrombosis. Rates of target-vessel revascularization for reasons unrelated to myocardial infarction were 3.7% among patients receiving sirolimus-eluting stents, 3.1% among those receiving everolimus-eluting stents, and 8.9% among those receiving bare-metal stents. The rate of target-vessel revascularization was significantly reduced among patients receiving either drug-eluting stent, as compared with a bare-metal stent, with no significant difference between the two types of drug-eluting stents.
  
  
  CONCLUSIONS
  In patients requiring stenting of large coronary arteries, no significant differences were found among sirolimus-eluting, everolimus-eluting, and bare-metal stents with respect to the rate of death or myocardial infarction. With the two drug-eluting stents, similar reductions in rates of target-vessel revascularization were seen. (Funded by the Basel Cardiovascular Research Foundation and the Swiss National Foundation for Research; Current Controlled Trials number, ISRCTN72444640.).
authors.affiliation: Department of Cardiology, University Hospital, CH 4031 Basel, Switzerland. ckaiser@uhbs.ch
authors.forename: Christoph
authors.initials: C
authors.lastname: Kaiser
authors.forename: Soeren
authors.initials: S
authors.lastname: Galatius
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
authors.forename: Franz
authors.initials: F
authors.lastname: Eberli
authors.forename: Hannes
authors.initials: H
authors.lastname: Alber
authors.forename: Hans
authors.initials: H
authors.lastname: Rickli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pedrazzini
authors.forename: Burkhard
authors.initials: B
authors.lastname: Hornig
authors.forename: Osmund
authors.initials: O
authors.lastname: Bertel
authors.forename: Piero
authors.initials: P
authors.lastname: Bonetti
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Brunner-La Rocca
authors.forename: Ingrid
authors.initials: I
authors.lastname: Ricard
authors.forename: Matthias
authors.initials: M
authors.lastname: Pfisterer
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000628:therapy*; D003331:Coronary Vessels / Q000033:anatomy & histology; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D011446:Prospective Studies; D019233:Retreatment; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D015607:Stents
chemical_list: D000068338:Everolimus; D020123:Sirolimus