title: A randomized comparison of platinum chromium-based everolimus-eluting stents versus cobalt chromium-based Zotarolimus-Eluting stents in all-comers receiving percutaneous coronary intervention: HOST-ASSURE (harmonizing optimal strategy for treatment of coronary artery stenosis-safety & effectiveness of drug-eluting stents & anti-platelet regimen), a randomized, controlled, noninferiority trial.
abstract: OBJECTIVE
  This study sought to test whether the newly developed platinum chromium (PtCr)-based everolimus-eluting stent (EES) is noninferior to the cobalt chromium (CoCr)-based zotarolimus-eluting stent (ZES) in all-comers receiving percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  PtCr provides improved radial strength, conformability, and visibility compared with the CoCr alloy, but PtCr-based stents have not been tested in a wide range of patients receiving PCI. Also, recent case series have raised the issue of longitudinal stent deformation (LSD) with newer drug-eluting stents.
  
  
  METHODS
  We randomly assigned 3,755 all-comers receiving PCI to PtCr-EES or CoCr-ZES. The primary outcome was target lesion failure (TLF) at 1-year post-PCI, defined as the composite of cardiac death, nonfatal target vessel-related myocardial infarction, and ischemia-driven target lesion revascularization. Post-hoc angiographic analysis was performed to qualitatively and quantitatively analyze LSD.
  
  
  RESULTS
  At 1 year, TLF occurred in 2.9% and 2.9% of the population in the PtCr-EES and CoCr-ZES groups, respectively (superiority p = 0.98, noninferiority p = 0.0247). There were no significant differences in the individual components of TLF as well as the patient-oriented clinical outcome. Of 5,010 stents analyzed, LSD occurred in 0.2% and 0% in the PtCr-EES and CoCr-ZES groups, respectively (p = 0.104). There was no significant difference in post-deployment stent length ratio between the 2 stents (p = 0.352).
  
  
  CONCLUSIONS
  At 1 year, PtCr-EES was noninferior to CoCr-ZES in all-comers receiving PCI. Although LSD was observed only in PtCr-EES, both the stent length ratio and the frequency of LSD were not significantly different between the 2 stent types, and PtCr-EES was not associated with adverse clinical outcomes. (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-SAfety & EffectiveneSS of Drug-ElUting Stents & Anti-platelet REgimen [HOST-ASSURE]; NCT01267734).
authors.affiliation: Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Kyung Woo
authors.initials: KW
authors.lastname: Park
authors.affiliation: Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Si-Hyuck
authors.initials: SH
authors.lastname: Kang
authors.affiliation: Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Hyun-Jae
authors.initials: HJ
authors.lastname: Kang
authors.affiliation: Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
authors.affiliation: Dankook University Hospital, Cheonan, Republic of Korea.
authors.forename: Byoung-Eun
authors.initials: BE
authors.lastname: Park
authors.affiliation: Busan National University Hospital, Busan, Republic of Korea.
authors.forename: Kwang Soo
authors.initials: KS
authors.lastname: Cha
authors.affiliation: Presbyterian Medical Center, Jeonju, Republic of Korea.
authors.forename: Jay Young
authors.initials: JY
authors.lastname: Rhew
authors.affiliation: Uijeongbu St. Mary's Hospital, Uijeongbu, Republic of Korea.
authors.forename: Hui-Kyoung
authors.initials: HK
authors.lastname: Jeon
authors.affiliation: Ulsan University Hospital, Ulsan, Republic of Korea.
authors.forename: Eun-Seok
authors.initials: ES
authors.lastname: Shin
authors.affiliation: Samsung Changwon Hospital, Changwon, Republic of Korea.
authors.forename: Ju Hyeon
authors.initials: JH
authors.lastname: Oh
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Myung-Ho
authors.initials: MH
authors.lastname: Jeong
authors.affiliation: Boramae Medical Center, Seoul, Republic of Korea.
authors.forename: Sanghyun
authors.initials: S
authors.lastname: Kim
authors.affiliation: Chungbuk National University Hospital, Cheongju, Republic of Korea.
authors.forename: Kyung-Kuk
authors.initials: KK
authors.lastname: Hwang
authors.affiliation: Wonju Christian Hospital, Wonju, Republic of Korea.
authors.forename: Jung-Han
authors.initials: JH
authors.lastname: Yoon
authors.affiliation: Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.
authors.forename: Sung Yun
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Dong-A Medical Center, Busan, Republic of Korea.
authors.forename: Tae-Ho
authors.initials: TH
authors.lastname: Park
authors.affiliation: St. Vincent's Hospital, Suwon, Republic of Korea.
authors.forename: Keon Woong
authors.initials: KW
authors.lastname: Moon
authors.affiliation: Gangnam Severance Hospital, Seoul, Republic of Korea.
authors.forename: Hyuck-Moon
authors.initials: HM
authors.lastname: Kwon
authors.affiliation: Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Hur
authors.affiliation: Daegu Catholic University Medical Center, Daegu, Republic of Korea.
authors.forename: Jae-Kean
authors.initials: JK
authors.lastname: Ryu
authors.affiliation: Daegu Fatima Hospital, Daegu, Republic of Korea.
authors.forename: Bong-Ryul
authors.initials: BR
authors.lastname: Lee
authors.affiliation: Gyeongsang National University Hospital, Jinju, Republic of Korea.
authors.forename: Yong Whi
authors.initials: YW
authors.lastname: Park
authors.affiliation: Seoul National University Bundang Hospital, Seongnam, Republic of Korea. Electronic address: ihchae@snu.ac.kr.
authors.forename: In-Ho
authors.initials: IH
authors.lastname: Chae
authors.affiliation: Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: hyosoo@snu.ac.kr.
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000970:Antineoplastic Agents; D002858:Chromium Alloys; D017608:Chromium Compounds; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017671:Platinum Compounds; D011446:Prospective Studies; D011474:Prosthesis Design; D056910:Republic of Korea; D016037:Single-Blind Method; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D002858:Chromium Alloys; D017608:Chromium Compounds; D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors; D017671:Platinum Compounds; D000068338:Everolimus; C489443:zotarolimus; D020123:Sirolimus
keywords: all-comers trial; clinical outcome; drug-eluting stent(s); percutaneous coronary intervention