Korean Circ J.  2012 Apr;42(4):266-273. 10.4070/kcj.2012.42.4.266.

Long-Term Safety and Efficacy of Sirolimus- and Paclitaxel-Eluting Stents in Patients With Acute Myocardial Infarction: Four-Year Observational Study

• Min GS
• Lee JH
• Park JH
• Choi UL
• Lee YD
• Seong SW
• Jin SA
• Park SJ
• Kim JH
• Park JH
• Choi SW
• Jeong JO
• Seong IW

• KMID: 2225020
• DOI: http://doi.org/10.4070/kcj.2012.42.4.266

Abstract

BACKGROUND AND OBJECTIVES
The comparison of long-term clinical effects between Sirolimus-eluting stent (SES) and Paclitaxel-eluting stents (PES) for treatment of acute myocardial infarction (AMI) remains unclear. Seeking to clarify this issue, we performed a retrospective analysis to evaluate four-year clinical outcomes of SES compared to PES treated AMI patients.
SUBJECTS AND METHODS
From January 2004 to August 2006, all patients with acute ST-segment elevation myocardial infarction and acute non-ST segment elevation myocardial infarction who underwent percutaneous coronary intervention (PCI) by implantation of either SES or PES were enrolled. The occurrences of cardiac and non-cardiac deaths, recurrent infarction, target vessel revascularization (TVR) and stent thrombosis were analyzed. The composite end points of these major adverse cardiac events (MACE) were also analyzed.
RESULTS
During the study period, a total of 668 AMI patients had visited, of which 522 patients (299 with SES and 223 with PES) were enrolled. During the four-year clinical follow-up, both groups showed similar occurrences of non-cardiac death (14.6+/-2.2% vs. 18.3+/-3.0%, p=0.26); cardiac death (6.8+/-1.52% vs. 11.2+/-2.6%, p=0.39); re-infarction (3.3+/-1.1% vs. 6.4+/-1.8%, p=0.31); and stent thrombosis (3.2+/-1.1% vs. 5.4+/-1.7%, p=0.53). However, occurrences of TVR {4.0+/-1.2% vs. 10.0+/-3.0%, hazard ratio (HR)=0.498, 95% confidence interval (CI)=0.257-0.967, p=0.039} and MACE (19.4+/-2.5% vs. 29.4+/-3.5%, HR=0.645, 95% CI=0.443-0.940, p=0.021) were significantly lower in the SES population.
CONCLUSION
In AMI patients treated with either SES or PES implantation, the former had a significantly lower risk of TVR and MACE during four-year clinical follow-up. Rates of death, cardiac death or recurrent infarction, and stent thrombosis were similar.

Keyword

Acute myocardial infarction; Percutaneous coronary intervention; Stents

MeSH Terms

Death
Follow-Up Studies
Glycosaminoglycans
Humans
Infarction
Myocardial Infarction
Percutaneous Coronary Intervention
Retrospective Studies
Stents
Thrombosis
Glycosaminoglycans

Figure

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  Fig. 1 Study population. STEMI: ST-elevation myocardial infarction, NSTEMI: non-ST elevation myocardial infarction, BMS: bare-metal stent, DES: drug-eluting stent, PCI: percutaneous coronary intervention, SES: Sirolimus-eluting stent, PES: Paclitaxel-eluting stent.

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  Fig. 2 Four-year clinical outcomes in STEMI patients (n=334). A: total mortality. B: cardiac mortality. C: re-infarction. D: target vessel revascularization. E: stent thrombosis (definite+probable). F: major adverse cardiac events. STEMI: ST-elevation myocardial infarction, PES: Paclitaxel-eluting stent, SES: Sirolimus-eluting stent.

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  Fig. 3 Four-year clinical outcomes in NSTEMI patients (n=188). A: total mortality. B: cardiac mortality. C: re-infarction. D: target vessel revascularization. E: stent thrombosis (definite+probable). F: major adverse cardiac events. NSTEMI: non-ST elevation myocardial infarction, PES: Paclitaxel-eluting stent, SES: Sirolimus-eluting stent.

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  Fig. 4 Four-year clinical outcomes in all patients (n=522). A: total mortality. B: cardiac mortality. C: re-infarction. D: target vessel revascularization. E: stent thrombosis (definite+probable). F: major adverse cardiac events. PES: Paclitaxel-eluting stent, SES: Sirolimus-eluting stent.

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