title: Safety and efficacy of sirolimus-eluting stent implantation in patients with acute coronary syndrome in the real world.
abstract: The use of drug-eluting stents in patients with acute coronary syndrome (ACS), particularly those with acute myocardial infarction (AMI), is controversial owing to concerns about late adverse events. We evaluated the long-term safety of sirolimus-eluting stent implantation in patients with ACS. Of 10,778 patients treated exclusively with a sirolimus-eluting stent in the j-Cypher registry, the 3-year outcomes of 2,308 patients with ACS (953 patients with AMI) were compared to those of 8,470 patients without ACS. Compared to patients without ACS, the patients with ACS had a significantly greater adjusted risk of death or myocardial infarction (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.12 to 1.37, p <0.0001) and definite or probable stent thrombosis (HR 1.43, 95% CI 1.11 to 1.82, p = 0.006) within the first year after sirolimus-eluting stent implantation. However, after 1 year, patients with ACS no longer had a greater risk of death or myocardial infarction (HR 1.01, 95% CI 0.90 to 1.13, p = 0.87) and stent thrombosis (HR 1.32, 95% CI 0.92 to 1.86, p = 0.13). Of the patients with ACS, those with AMI had a greater risk of death or myocardial infarction (HR 1.33, 95% CI 1.12 to 1.6, p = 0.001) and stent thrombosis (HR 1.57, 95% CI 1.05 to 2.39, p = 0.03) than those with unstable angina pectoris within the first year. However, they had a similar risk of death or myocardial infarction (HR 1.00, 95% CI 0.78 to 1.22, p = 0.83) and stent thrombosis (HR 0.83, 95% CI 0.38 to 1.6, p = 0.59) after 1 year. The risk of late adverse events >1 year after sirolimus-eluting stent implantation was similar between those with and without ACS and between those with AMI and those with unstable angina pectoris.
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
authors.forename: Ren
authors.initials: R
authors.lastname: Kawaguchi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Shigeru
authors.initials: S
authors.lastname: Oshima
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hoshizaki
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kawai
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shiode
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hiasa
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D020123:Sirolimus / Q000494:pharmacology*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus