Long-term safety and efficacy of the everolimus-eluting stent compared to first-generation drug-eluting stents in contemporary clinical practice.
OBJECTIVE
This study aimed to assess the long-term safety and clinical effectiveness of the Xience V everolimus-eluting stent (EES) compared to both Taxus paclitaxel-eluting stent (PES) and Cypher sirolimus-eluting stent (SES) in an unselected patient population.


BACKGROUND
There are limited long-term data comparing Xience V EES vs the first-generation Cypher SES.


METHODS
This retrospective analysis included 6069 patients treated with Cypher SES, Taxus PES, or Xience V EES from 2003-2009 at our institution. Patients were followed by telephone contact or office visit up to 2 years after the index procedure.


RESULTS
Baseline characteristics were generally comparable, with the exception of a significantly higher prevalence of diabetes mellitus, systemic hypertension, history of angioplasty, and coronary bypass surgery among Xience V EES patients. At 2 years, the incidence of major adverse cardiovascular events was 13.3% (Xience V EES) vs 17.8% (Cypher SES) vs 22% (Taxus PES) (P<.001). The main drivers for the differences in event rates were lower mortality, the need for target vessel revascularization, and Q-wave myocardial infarction. Stent thrombosis was lowest in Xience V EES patients (0.2% vs 1.2% SES vs 0.7% PES, respectively; P=.01). A landmark analysis after 1 year showed that the benefits of Xience V EES continued in long-term follow-up.


CONCLUSIONS
In a contemporary clinical United States practice with an unselected patient population, Xience V EES use was associated with improved safety profile and reduction of all-cause mortality and stent thrombosis when compared to both first-generation drug-eluting stents. This superiority continues to widen from 1 to 2 years.
MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010 USA. ron.waksman@medstar.net.
Israel M
IM
Barbash
Sa'ar
S
Minha
Rebecca
R
Torguson
Itsik
I
Ben-Dor
Salem
S
Badr
Joshua P
JP
Loh
Lowell F
LF
Satler
Augusto D
AD
Pichard
Ron
R
Waksman
D000368:Aged; D003324:Coronary Artery Disease / Q000628:therapy*; D023921:Coronary Stenosis / Q000453:epidemiology / Q000209:etiology; D054855:Drug-Eluting Stents / Q000009:adverse effects; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D017239:Paclitaxel; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation* / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D020123:Sirolimus / Q000031:analogs & derivatives*; D016896:Treatment Outcome
D000068338:Everolimus; D017239:Paclitaxel; D020123:Sirolimus