Long-Term Comparison of Everolimus-Eluting and Sirolimus-Eluting Stents for Coronary Revascularization

被引:80
作者
Raeber, Lorenz [1 ]
Jueni, Peter [2 ,3 ]
Nueesch, Eveline [3 ]
Kalesan, Bindu [3 ]
Wenaweser, Peter [1 ]
Moschovitis, Aris [1 ]
Khattab, Ahmed A. [1 ]
Bahlo, Maryam [1 ]
Togni, Mario [1 ]
Cook, Stephane [1 ]
Vogel, Rolf [1 ]
Seiler, Christian [1 ]
Meier, Bernhard [1 ]
Windecker, Stephan [1 ,2 ]
机构
[1] Univ Hosp Bern, Dept Cardiol, CH-3010 Bern, Switzerland
[2] Univ Hosp Bern, Clin Trials Unit, CH-3010 Bern, Switzerland
[3] Univ Bern, Inst Social & Prevent Med, Bern, Switzerland
基金
瑞士国家科学基金会;
关键词
coronary disease; drug-eluting stents; stent thrombosis; LARGE 2-INSTITUTIONAL COHORT; ROUTINE CLINICAL-PRACTICE; ARTERY-DISEASE; METAANALYSIS; THROMBOSIS; POLYMER; TRIALS;
D O I
10.1016/j.jacc.2011.01.023
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives This study sought to compare the unrestricted use of everolimus-eluting stents (EES) with sirolimus-eluting stents (SES) in patients undergoing percutaneous coronary intervention. Background It is unclear whether there are differences in safety and efficacy between EES and SES during long-term follow-up. Methods Using propensity score matching, clinical outcome was compared among 1,342 propensity score-matched pairs of patients treated with EES and SES. The primary outcome was a composite of death, MI, and target vessel revascularization. Results The median follow-up was 1.5 years with a maximum of 3 years. The primary outcome occurred in 14.9% of EES- and 18.0% of SES-treated patients up to 3 years (hazard ratio [HR]: 0.83, 95% confidence interval [CI]: 0.68 to 1.00, p = 0.056). All-cause mortality (6.0% vs. 6.5%, HR: 0.92, 95% CI: 0.68 to 1.25, p = 0.59) was similar, risks of myocardial infarction (MI) (3.3% vs. 5.0%, HR: 0.62, 95% CI: 0.42 to 0.92, p = 0.017), and target vessel revascularization (7.0% vs. 9.6%, HR: 0.75, 95% CI: 0.57 to 0.99, p = 0.039) were lower with EES than SES. Definite stent thrombosis (ST) (HR: 0.30, 95% CI: 0.12 to 0.75, p = 0.01) was less frequent among patients treated with EES. The reduced rate of MI with EES was explained in part by the lower risk of definite ST and the corresponding decrease in events associated with ST (HR: 0.25, 95% CI: 0.08 to 0.75, p = 0.013). Conclusions The unrestricted use of EES appears to be associated with improved clinical long-term outcome compared with SES. Differences in favor of EES are driven in part by a lower risk of MI associated with ST. (J Am Coll Cardiol 2011; 57: 2143-51) (C) 2011 by the American College of Cardiology Foundation
引用
收藏
页码:2143 / 2151
页数:9
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