Long-term outcomes of patients receiving zotarolimus-eluting stents in ST elevation myocardial infarction, non-ST elevation acute coronary syndrome, and stable angina: data from the Resolute program.

Abstract

BACKGROUND:

Outcome data are limited in patients with ST-segment elevation acute myocardial infarction (STEMI) or other acute coronary syndromes (ACSs) who receive a drug-eluting stent (DES). Data suggest that first generation DES is associated with an increased risk of stent thrombosis when used in STEMI. Whether this observation persists with newer generation DES is unknown. The study objective was to analyze the two-year safety and effectiveness of Resolute™ zotarolimus-eluting stents (R-ZESs) implanted for STEMI, ACS without ST segment elevation (non-STEACS), and stable angina (SA).

METHODS:

Data from the Resolute program (Resolute All Comers and Resolute International) were pooled and patients with R-ZES implantation were categorized by indication: STEMI (n=335), non-STEACS (n=1416), and SA (n=1260).

RESULTS:

Mean age was 59.8±11.3 years (STEMI), 63.8±11.6 (non-STEACS), and 64.9±10.1 (SA). Fewer STEMI patients had diabetes (19.1% vs. 28.5% vs. 29.2%; P<0.001), prior MI (11.3% vs. 27.2% vs. 29.4%; P<0.001), or previous revascularization (11.3% vs. 27.9% vs. 37.6%; P<0.001). Two-year definite/probable stent thrombosis occurred in 2.4% (STEMI), 1.2% (non-STEACS) and 1.1% (SA) of patients with late/very late stent thrombosis (days 31-720) rates of 0.6% (STEMI and non-STEACS) and 0.4% (SA) (P=NS). The two-year mortality rate was 2.1% (STEMI), 4.8% (non-STEACS) and 3.7% (SA) (P=NS). Death or target vessel re-infarction occurred in 3.9% (STEMI), 8.7% (non-STEACS) and 7.3% (SA) (P=0.012).

CONCLUSION:

R-ZES in STEMI and in other clinical presentations is effective and safe. Long term outcomes are favorable with an extremely rare incidence of late and very late stent thrombosis following R-ZES implantation across indications.

• Authors: Petr Widimsky, Zuzana Motovska, Jorge Belardi, Patrick Serruys, Sigmund Silber, Stephan Windecker, Franz-Josef Neumann
• Journal: International journal of cardiology (Int J Cardiol) Vol. 168 Issue 4 Pg. 3522-6 (Oct 09 2013) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 23706326 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• zotarolimus
• Sirolimus

Topics

• Acute Coronary Syndrome (diagnosis, therapy)
• Aged
• Angina, Stable (diagnosis, therapy)
• Drug-Eluting Stents (adverse effects)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Myocardial Infarction (diagnosis, therapy)
• Sirolimus (administration & dosage, adverse effects, analogs & derivatives)
• Time Factors
• Treatment Outcome