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. 2021 Mar 19;10(6):1278.
doi: 10.3390/jcm10061278.

Five-Year Comparative Efficacy of Everolimus-Eluting vs. Resolute Zotarolimus-Eluting Stents in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Endrin Koni  1   2 , Wojciech Wanha  3 , Jakub Ratajczak  4   5 , Zhongheng Zhang  6   7 , Przemysław Podhajski  4 , Rita L. Musci  8 , Giuseppe M. Sangiorgi  9 , Maciej Kaźmierski  3 , Antonio Buffon  10 , Jacek Kubica  4 , Wojciech Wojakowski  3 , Eliano P. Navarese  2   4   11
Affiliations

Five-Year Comparative Efficacy of Everolimus-Eluting vs. Resolute Zotarolimus-Eluting Stents in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Endrin Koni et al. J Clin Med. .

Abstract

Among drug-eluting stents (DESs), the durable polymer everolimus-eluting stent (EES) and resolute zotarolimus-eluting stent (R-ZES) are widely used in clinical practice and have contributed to improve the outcomes of patients undergoing percutaneous coronary intervention (PCI). Few studies addressed their long-term comparative performance in patients with acute coronary syndrome (ACS). We aimed to investigate the 5 year comparative efficacy of EES and R-ZES in ACS. We queried ACTION-ACS, a large-scale database of ACS patients undergoing PCI. The treatment groups were analyzed using propensity score matching. The primary endpoint was a composite of mortality, myocardial infarction (MI), stroke, repeat PCI, and definite or probable stent thrombosis, which was addressed at the five-year follow-up. A total of 3497 matched patients were analyzed. Compared with R-ZES, a significant reduction in the primary endpoint at 5 years was observed in patients treated with EES (hazard ratio (HR) [95%CI] = 0.62 [0.54-0.71], p < 0.001). By landmark analysis, differences between the two devices emerged after the first year and were maintained thereafter. The individual endpoints of mortality (HR [95%CI] = 0.70 [0.58-0.84], p < 0.01), MI (HR [95%CI] = 0.55 [0.42-0.74], p < 0.001), and repeat PCI (HR [95%CI] = 0.65 [0.53-0.73], p < 0.001) were all significantly lower in the EES-treated patients. Stroke risk did not differ between EES and R-ZES. In ACS, a greater long-term clinical efficacy with EES vs. R-ZES was observed. This difference became significant after the first year of the ACS episode and persisted thereafter.

Keywords: acute coronary syndrome; everolimus-eluting stent; resolute zotarolimus-eluting stent.

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Conflict of interest statement

Prof Wojakowski reports speaker or consultancy fees from Abbott, Boston Scientific and Medtronic, outside the submitted work. Prof Navarese reports research grants from Abbott, Amgen, and lecture fees/honoraria from Amgen, Astra-Zeneca, Bayer, Pfizer and Sanofi-Regeneron, outside the submitted work. The others authors have no conflict to disclose.

Figures

Figure 1
Figure 1
Study flow chart. EES, everolimus-eluting stent; R-ZES, resolute zotarolimus-eluting stent; MACCE, major adverse cardiovascular and cerebrovascular events; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
(A) Kaplan–Meier graph of the cumulative incidence of MACCE. (B) The time-to-event landmark analysis showing event curve divergence that became statistically significant after the one year landmark point.
Figure 3
Figure 3
Kaplan–Meier graph of the cumulative incidence of mortality.
Figure 4
Figure 4
Kaplan–Meier graph of the cumulative incidence of myocardial infarction.
Figure 5
Figure 5
Kaplan–Meier graph of the cumulative incidence of repeat PCI.
Figure 6
Figure 6
Forest plot analysis of the prespecified subgroups. CCS, Canadian Cardiovascular Society Grading Angina; NYHA, New York Heart Association heart failure classification; PCI, percutaneous coronary intervention.
See this image and copyright information in PMC

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