title: Long-term safety and efficacy of second-generation everolimus-eluting stents compared to other limus-eluting stents and bare metal stents in patients with acute coronary syndrome.
abstract: OBJECTIVE
  This study aimed to investigate the long-term safety and efficacy of everolimus-eluting stents (EES) compared with other limus-eluting stents and bare metal stents (BMS) in ACS patients.
  
  
  BACKGROUND
  There have been concerns about the long-term safety of drug-eluting stents in the setting of acute coronary syndrome.
  
  
  METHODS
  The study cohort included 1,612 patients presenting with acute coronary syndrome who underwent BMS, SES, E-ZES, or EES implantation. End points included probable or definite stent thrombosis and major adverse cardiovascular events (MACE), defined as a composite of all-cause death, Q-wave myocardial infarction, and target lesion revascularization up to 3 years.
  
  
  RESULTS
  The overall MACE rates were significantly higher for both BMS and SES, but not E-ZES, when compared with EES (EES vs. BMS: HR 2.68, 95% CI 1.91-3.78, P <0.001; EES vs. SES: HR 1.75, 95% CI 1.24-2.47, P = 0.001 and EES vs.
  HR 1.08, 95% CI 0.65-1.77, P = 0.72). Stent thrombosis rates were similar for EES, E-ZES, and BMS but higher for SES throughout the 3-year follow-up (EES vs. BMS: HR 1.02, 95% CI: 0.31-3.35, P = 0.973; EES vs. SES: HR 4.90, 95% CI: 1.75-13.69, P = 0.002 and EES vs.
  HR 1.63, 95% CI 0.37-7.31, P = 0.449).
  
  
  CONCLUSIONS
  There was an improvement in the long-term outcome for MACE with EES when compared to earlier-generation stents, but this was comparable with the 2nd-generation E-ZES. There was no additional risk of early or late stent thrombosis in EES when compared with BMS.
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Alfazir
authors.initials: A
authors.lastname: Omar
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: Hironori
authors.initials: H
authors.lastname: Kitabata
authors.forename: Lakshmana K
authors.initials: LK
authors.lastname: Pendyala
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Loh
authors.forename: Marco A
authors.initials: MA
authors.lastname: Magalhaes
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D000970:Antineoplastic Agents; D002423:Cause of Death / Q000639:trends; D023903:Coronary Restenosis / Q000453:epidemiology / Q000517:prevention & control*; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000494:pharmacology; D013997:Time Factors; D016896:Treatment Outcome; D014861:Washington / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus
keywords: acute coronary syndrome; bare metal stent; everolimus; sirolimus; zotarolimus