title: Impact of drug-eluting stent type on periprocedural myocardial necrosis.
abstract: OBJECTIVE
  The relationship between stent design and periprocedural myocardial infarction is unclear. The newest type of drug-eluting stent (DES), the everolimus-eluting stent (EES), has thinner strut and polymer thickness and a small amount of drug. EES use, therefore, could be related to less myocardial necrosis post-percutaneous coronary intervention (PCI). This study was undertaken to compare the amount of myocardial necrosis associated with implantation of the four DES types currently approved in the U.S.
  
  
  RESULTS
  A cohort of 7,259 consecutive patients who underwent elective PCI with DES implantation from 2003 to 2010 was studied. Sirolimus-eluting stents were deployed in 4420, paclitaxel-eluting stents in 1858, zotarolimus-eluting stents in 308, and EES in 673. The maximum creatine phosphokinase-MB (CPK-MB) was measured post-procedure and served as the primary endpoint. Patients who received EES had the smallest CPK-MB rise (p<0.0001) among the four groups. Further, a post-PCI increase was less often large enough to meet any of the usual criteria for periprocedural myocardial infarction used in clinical studies. After adjustment for baseline and angiographic characteristics, paclitaxel-, sirolimus-, and zotarolimus-eluting stent groups more frequently exceeded the CPK-MB >5x normal limit compared with EES-treated patients (OR=2.44, p=0.01; OR=2.01, p=0.05; OR=1.80, p=0.2, respectively).
  
  
  CONCLUSIONS
  It is plausible that EES with their superior design are associated with less periprocedural myocardial injury compared with older-generation DES.
authors.affiliation: Division of Cardiology, Washington Hospital Center, Washington, DC, USA.
authors.forename: Kohei
authors.initials: K
authors.lastname: Wakabayashi
authors.forename: Cedric
authors.initials: C
authors.lastname: Delhaye
authors.forename: Michael
authors.initials: M
authors.lastname: Mahmoudi
authors.forename: Loic
authors.initials: L
authors.lastname: Belle
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gaglia
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Joseph
authors.initials: J
authors.lastname: Lindsay
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D052279:Creatine Kinase, MB Form / Q000097:blood; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D000068338:Everolimus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D000068338:Everolimus; D052279:Creatine Kinase, MB Form; D020123:Sirolimus