Long-Term Comparison of Everolimus- and Sirolimus-Eluting Stents in Patients With Acute Coronary Syndromes

Objectives The goal of this study was to compare the long-term clinical outcome between everolimus-eluting stent (EES) and sirolimus-eluting stent (SES) in patients with acute coronary syndromes (ACS). Background EES have not been directly compared with SES in ACS patients to date. Methods Between 2004 and 2009, 1,746 consecutive ACS patients (ST-segment elevation ACS [STE-ACS]: 33.5%; non-ST-segment elevation ACS [NSTE-ACS]: 66.5%) were treated with EES (n = 903) or SES (n = 843). Using propensity score matching, clinical outcome was compared among 705 matched pairs of ACS patients treated with EES and SES. Results Through 3 years, the primary endpoint-the composite of death, myocardial infarction (MI), and target vessel revascularization (TVR)-occurred in 13.8% of EES- and 17.7% of SES-treated ACS patients (hazard ratio [HR]: 0.72, 95% confidence interval [CI]: 0.54 to 0.95, p = 0.02). The difference in favor of EES was driven by a lower risk of TVR (5.7% vs. 8.8%, HR: 0.65, 95% CI: 0.43 to 0.98, p = 0.04) and a trend toward a lower risk of MI (2.1% vs. 3.3%, HR: 0.56, 95% CI: 0.29 to 1.12, p = 0.10). The risk of death (7.2% vs. 8.8%, HR: 0.75, 95% CI: 0.50 to 1.10, p = 0.14) showed no difference between EES and SES. The treatment effect in favor of EES for the primary endpoint was similar for patients with STE-ACS (16.4% vs. 18.5%, HR: 0.80, 95% CI: 0.50 to 1.27) and NSTE-ACS (12.4% vs. 17.3%; HR: 0.67, 95% CI: 0.47 to 0.96; p(for interaction) = 0.56) and across major subgroups. Definite (0.4% vs. 1.8%, p = 0.03), and definite or probable stent thrombosis (3.4% vs. 6.1%, p = 0.02) were less frequent among EES- than SES-treated ACS patients. Conclusions Among patients with ACS, the unrestricted use of EES is associated with improved clinical outcome compared with SES during long-term follow-up to 3 years. Notably, the risk of stent thrombosis was lower among EES-treated ACS patients. (J Am Coll Cardiol Intv 2012;5: 145-54) (C) 2012 by the American College of Cardiology Foundation