Comparison of the efficacy and safety of zotarolimus-, sirolimus-, and paclitaxel-eluting stents in patients with ST-elevation myocardial infarction.

Abstract

Drug-eluting stents (DESs) are increasingly used for treatment of acute ST-segment elevation myocardial infarction (STEMI), but there are few comparisons of outcomes of various types of DES. We compared the efficacy and safety of zotarolimus-eluting stents (ZESs), sirolimus-eluting stents (SESs), and paclitaxel-eluting stents (PESs) in primary intervention for STEMI. This multicenter, prospectively randomized ZEST-AMI trial included 328 patients at 12 medical centers who were randomly assigned to ZES (n = 108), SES (n = 110), or PES (n = 110) deployment. The primary end point was major adverse cardiac events (death, MI, and ischemia-driven target vessel revascularization) at 12 months. Secondary end points included the individual components of the primary end point, late loss, angiographic restenosis, and stent thrombosis. Baseline clinical and angiographic characteristics were well matched. In-segment late loss (0.28 +/- 0.42 vs 0.46 +/- 0.48 vs 0.47 +/- 0.50 mm, respectively, p = 0.029) and restenosis rate (2.7% vs 15.9% vs 12.3%, respectively, p = 0.027) at 8 months were lowest in the SES group compared to the ZES and PES groups. At 12 months, cumulative incidence rates of primary end points in the ZES, SES, and PES groups were 11.3%, 8.2%, and 8.2%, respectively (p = 0.834). There were 2 acute (in the SES group) and 5 subacute (2 in the SES group and 3 in the PES group) stent thromboses. Incidence of death, recurrent MI, or ischemia-driven target vessel revascularization did not differ among the 3 groups. In conclusion, despite the difference in restenosis rate, the efficacy and safety of the 3 different DESs showed similar, acceptable results in the treatment of STEMI.

• Authors: Cheol Whan Lee, Duk-Woo Park, Seung-Hwan Lee, Young-Hak Kim, Myeong-Ki Hong, Jae-Joong Kim, Seong-Wook Park, Sung-Cheol Yun, In-Whan Seong, Jae-Hwan Lee, Nae-Hee Lee, Yoon Haeng Cho, Sang-Sig Cheong, Do-Sun Lim, Joo-Young Yang, Sang-Gon Lee, Kee-Sik Kim, Junghan Yoon, Myung-Ho Jeong, Ki Bae Seung, Taeg Jong Hong, Seung-Jung Park, ZEST-AMI Investigators
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 104 Issue 10 Pg. 1370-6 (Nov 15 2009) ISSN: 1879-1913 [Electronic] United States
• PMID: 19892052 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Cardiovascular Agents
• Platelet Aggregation Inhibitors
• Clopidogrel
• zotarolimus
• Ticlopidine
• Paclitaxel
• Aspirin
• Sirolimus

Topics

• Angioplasty, Balloon, Coronary
• Aspirin (therapeutic use)
• Cardiovascular Agents (therapeutic use)
• Clopidogrel
• Coronary Angiography
• Coronary Restenosis (epidemiology)
• Coronary Thrombosis (epidemiology)
• Drug-Eluting Stents
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (epidemiology, therapy)
• Myocardial Revascularization
• Paclitaxel (therapeutic use)
• Platelet Aggregation Inhibitors (therapeutic use)
• Prospective Studies
• Recurrence
• Sirolimus (analogs & derivatives, therapeutic use)
• Ticlopidine (analogs & derivatives, therapeutic use)