title: Safety and efficacy of everolimus-eluting stents compared with first-generation drug-eluting stents in patients undergoing primary percutaneous coronary intervention.
abstract: OBJECTIVE
  To assess the safety and efficacy everolimus-eluting stents (EES) compared with first-generation drug-eluting stents (DES) in patients with acute myocardial infarction (MI) undergoing primary percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  EES have been associated with improved clinical outcomes compared to paclitaxel-eluting stents (PES) and with similar outcomes compared to sirolimus-eluting stents (SES).
  
  
  METHODS
  A total of 520 patients who presented with ST-elevation myocardial infarction (STEMI) from 2003 to 2013, who underwent primary PCI with DES, were retrospectively analyzed. Of these, 247 received SES, 136 PES, and 137 EES. Patients were followed up to 2 years for major adverse cardiac events (MACE). Univariate and multivariate models detected correlates to outcome.
  
  
  RESULTS
  EES implantation, compared with PES and SES, resulted in comparable rates of MACE (8.8% vs. 16.2%, p=0.06 and 8.8% vs. 12.6%, respectively, p=0.26), stent thrombosis, MI, and target lesion revascularization. Patients who received EES had lower rates of all-cause mortality (3.7% vs. 12.6% vs. 9.4%, p=0.03) at 1-year follow up. However, in the univariate and multivariate analyses, stent type was not independently associated with the primary outcome or with all-cause mortality. Diabetes mellitus and number of stents implanted were independently associated with the primary outcome.
  
  
  CONCLUSIONS
  While EES seem to be associated with better outcome when compared to PES, the main correlates of STEMI patients are the presence of diabetes and number of stents implanted, and not the type of stent used for intervention.
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Ricardo O
authors.initials: RO
authors.lastname: Escárcega
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Nevin C
authors.initials: NC
authors.lastname: Baker
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Magalhaes
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipinski
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Sa'ar
authors.initials: S
authors.lastname: Minha
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003328:Coronary Thrombosis / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D000068338:Everolimus / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D017239:Paclitaxel / Q000627:therapeutic use; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000068338:Everolimus; D017239:Paclitaxel
keywords: Everolimus-eluting stent; Paclitaxel-eluting stent; ST-elevation myocardial infarction; Sirolimus-eluting stent