title: Comparison of six-year clinical outcome of sirolimus- and paclitaxel-eluting stents to bare-metal stents in patients with ST-segment elevation myocardial infarction: an analysis of the RESEARCH (rapamycin-eluting stent evaluated at Rotterdam cardiology hospital) and T-SEARCH (taxus stent evaluated at Rotterdam cardiology hospital) registries.
abstract: BACKGROUND
  Short- and long-term data showed that drug-eluting stents (DES) significantly decreased target vessel revascularization (TVR) and major adverse cardiac event (MACE) rates compared to bare-metal stents (BMS). However, conflicting long-term data remain for patients with ST-segment elevation myocardial infarction (STEMI).
  
  
  OBJECTIVE
  Our aim was to assess the 6-year clinical outcome of all patients undergoing primary percutaneous coronary intervention (PPCI) for a de novo lesion with exclusive use of BMS, sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES).
  
  
  METHODS
  Three PPCI cohorts (BMS = 80; SES = 92; PES = 162) were systematically followed for the occurrence of MACE.
  
  
  RESULTS
  Very late stent thrombosis was more common after the implantation of SES as compared to PES or BMS (7.6%, 0.6%, and 0.0%, respectively; p = 0.001). Kaplan-Meier estimates indicate no statistically significant difference for mortality between the three stent types at 6 years (BMS = 25%; SES = 15%; PES = 21%; Log-rank p = 0.2). After adjustment for differences in baseline characteristics, mortality, mortality/myocardial infarction (MI), and MACE rates were significantly lower for SES compared to BMS, but not for PES (aHR = 0.41, 95% CI: 0.17-0.98; aHR = 0.44, 95% CI: 0.21-0.96; aHR = 0.35, 95% CI: 0.17-0.72, respectively). No differences were observed between the three stent types for TVR rates.
  
  
  CONCLUSIONS
  Neither SES nor PES improved safety or efficacy as compared to BMS in a STEMI population at 6 years. After adjusting, the usage of SES resulted in a significant decrease in mortality, mortality/MI and MACE rates as compared to BMS, in contrast to the usage of PES. SES and PES have a similar effectiveness and safety profile, although very late stent thrombosis was more common with SES.
authors.affiliation: Department of Cardiology, Thoraxcenter, Room Ba 583, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 RD, Rotterdam, the Netherlands.
authors.forename: Cihan
authors.initials: C
authors.lastname: Simsek
authors.forename: Michael
authors.initials: M
authors.lastname: Magro
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Nauta
authors.forename: Joost
authors.initials: J
authors.lastname: Daemen
authors.forename: Marcia
authors.initials: M
authors.lastname: Gaspersz
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: Willem
authors.initials: W
authors.lastname: van der Giessen
authors.forename: Ron
authors.initials: R
authors.lastname: van Domburg
authors.forename: Patrick
authors.initials: P
authors.lastname: Serruys
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods*; D023903:Coronary Restenosis / Q000453:epidemiology; D003328:Coronary Thrombosis / Q000453:epidemiology; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D009426:Netherlands; D017239:Paclitaxel; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D020123:Sirolimus; D015607:Stents; D016896:Treatment Outcome
chemical_list: D008670:Metals; D017239:Paclitaxel; D020123:Sirolimus