title: Long-term comparison of everolimus- and sirolimus-eluting stents in patients with acute coronary syndromes.
abstract: OBJECTIVE
  The goal of this study was to compare the long-term clinical outcome between everolimus-eluting stent (EES) and sirolimus-eluting stent (SES) in patients with acute coronary syndromes (ACS).
  
  
  BACKGROUND
  EES have not been directly compared with SES in ACS patients to date.
  
  
  METHODS
  Between 2004 and 2009, 1,746 consecutive ACS patients (ST-segment elevation ACS [STE-ACS]: 33.5%; non-ST-segment elevation ACS [NSTE-ACS]: 66.5%) were treated with EES (n=903) or SES (n=843). Using propensity score matching, clinical outcome was compared among 705 matched pairs of ACS patients treated with EES and SES.
  
  
  RESULTS
  Through 3 years, the primary endpoint-the composite of death, myocardial infarction (MI), and target vessel revascularization (TVR)-occurred in 13.8% of EES- and 17.7% of SES-treated ACS patients (hazard ratio [HR]: 0.72, 95% confidence interval [CI]: 0.54 to 0.95, p=0.02). The difference in favor of EES was driven by a lower risk of TVR (5.7% vs. 8.8%, HR: 0.65, 95% CI: 0.43 to 0.98, p=0.04) and a trend toward a lower risk of MI (2.1% vs. 3.3%, HR: 0.56, 95% CI: 0.29 to 1.12, p=0.10). The risk of death (7.2% vs. 8.8%, HR: 0.75, 95% CI: 0.50 to 1.10, p=0.14) showed no difference between EES and SES. The treatment effect in favor of EES for the primary endpoint was similar for patients with STE-ACS (16.4% vs. 18.5%, HR: 0.80, 95% CI: 0.50 to 1.27) and NSTE-ACS (12.4% vs. 17.3%; HR: 0.67, 95% CI: 0.47 to 0.96; pfor interaction=0.56) and across major subgroups. Definite (0.4% vs. 1.8%, p=0.03), and definite or probable stent thrombosis (3.4% vs. 6.1%, p=0.02) were less frequent among EES- than SES-treated ACS patients.
  
  
  CONCLUSIONS
  Among patients with ACS, the unrestricted use of EES is associated with improved clinical outcome compared with SES during long-term follow-up to 3 years. Notably, the risk of stent thrombosis was lower among EES-treated ACS patients.
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, and Clinical Trials Unit, Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Bindu
authors.initials: B
authors.lastname: Kalesan
authors.forename: Giulio G
authors.initials: GG
authors.lastname: Stefanini
authors.forename: Lorenz
authors.initials: L
authors.lastname: Räber
authors.forename: Mathieu
authors.initials: M
authors.lastname: Schmutz
authors.forename: Sandro
authors.initials: S
authors.lastname: Baumgartner
authors.forename: Sarah
authors.initials: S
authors.lastname: Hitz
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Baldinger
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
authors.forename: Aris
authors.initials: A
authors.lastname: Moschovitis
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.forename: Lutz
authors.initials: L
authors.lastname: Büllesfeld
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.forename: Peter
authors.initials: P
authors.lastname: Jüni
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000628:therapy; D016001:Confidence Intervals; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D018570:Risk Assessment / Q000379:methods; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus