title: Second-generation everolimus-eluting stents versus first-generation sirolimus-eluting stents in acute myocardial infarction. 1-year results of the randomized XAMI (XienceV Stent vs. Cypher Stent in Primary PCI for Acute Myocardial Infarction) trial.
abstract: OBJECTIVE
  The goal of this study was to compare the efficacy and safety of second-generation everolimus-eluting stents (EES) with first-generation sirolimus-eluting stents (SES) in primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).
  
  
  BACKGROUND
  Drug-eluting stents (DES) in AMI are still feared for possible late and very late stent thrombosis (ST). Newer-generation DES, with more hemocompatible polymers and improved healing, may show promise regarding increased efficacy of DES with improved safety. However, no randomized trials in AMI are available.
  
  
  METHODS
  A total of 625 patients with AMI were randomized (2:1) to receive EES or SES in the XAMI (XienceV Stent vs Cypher Stent in Primary PCI for Acute Myocardial Infarction) trial. Primary endpoint was major adverse cardiac events (MACE) at 1 year consisting of cardiac death, nonfatal AMI, or any target vessel revascularization. The study was powered for noninferiority of EES. Secondary endpoints comprised ST rates and MACE rate up to 3 years.
  
  
  RESULTS
  The MACE rate was 4.0% for EES and 7.7% for SES; the absolute difference was -3.7% (95% confidence interval: -8.28 to -0.03; p = 0.048) and relative risk was 0.52 (95% confidence interval: 0.27 to 1.00). One-year cardiac mortality was low at 1.5% for EES versus 2.7% for SES (p = 0.36), and 1-year incidence of definite and/or probable ST was 1.2% for EES versus 2.7% for SES (p = 0.21).
  
  
  CONCLUSIONS
  In this all-comer, randomized, multicenter AMI trial, second-generation EES was noninferior to SES, and superiority for MACE was suggested. ST rate in EES at 1-year was low, but long-term follow-up and larger studies will have to show whether very late ST rates will also be improved in newer DES. (XienceV Stent vs Cypher Stent in Primary PCI for Acute Myocardial Infarction [XAMI]; NTR1123).
authors: Medical Center Leeuwarden,Henri Dunantweg 2, Leeuwarden, the Netherlands. s.h.hofma@znb.nl
authors: Sjoerd H
authors: SH
authors: Hofma
authors: Jan
authors: J
authors: Brouwer
authors: Matthijs A
authors: MA
authors: Velders
authors: Arnoud W J
authors: AW
authors: van't Hof
authors: Pieter C
authors: PC
authors: Smits
authors: Michel
authors: M
authors: Queré
authors: Cornelis Jan
authors: CJ
authors: de Vries
authors: Adrianus J
authors: AJ
authors: van Boven
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002423:Cause of Death; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D009204:Myocardial Revascularization; D020123:Sirolimus / Q000031:analogs & derivatives*; D015996:Survival Rate
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus