The PASEO (PaclitAxel or Sirolimus-Eluting Stent Versus Bare Metal Stent in Primary Angioplasty) Randomized Trial

• Published in: JACC. Cardiovascular interventions 2009-06, Vol.2 (6), p.515-523
• Main Authors: Di Lorenzo, Emilio, MD, PhD, De Luca, Giuseppe, MD, PhD, Sauro, Rosario, MD, Varricchio, Attilio, MD, PhD, Capasso, Michele, MD, Lanzillo, Tonino, MD, Manganelli, Fiore, MD, Mariello, Ciro, MD, Siano, Francesco, MD, Pagliuca, Maria Rosaria, MD, Stanco, Giovanni, MD, Rosato, Giuseppe, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - instrumentation; Angioplasty, Balloon, Coronary - mortality; Cardiovascular; Cardiovascular Agents - administration & dosage; Coronary Angiography; Drug-Eluting Stents; Female; Humans; Kaplan-Meier Estimate; Male; Metals; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Paclitaxel - administration & dosage; Patient Selection; percutaneous coronary intervention; Platelet Aggregation Inhibitors - therapeutic use; Prospective Studies; Prosthesis Design; Recurrence; Risk Assessment; Sirolimus - administration & dosage; ST-segment elevation myocardial infarction; Stents; Thrombosis - etiology; Thrombosis - prevention & control; Time Factors; Treatment Outcome
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2009.03.012

Objectives The aim of this study was to evaluate the benefits of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) as compared with bare-metal stents (BMS) in patients undergoing primary angioplasty. Background Recent concerns have emerged on the potential higher risk of stent thrombosis after drug-eluting stent implantation, especially among ST-segment elevation myocardial infarction (STEMI) patients. Methods We randomly assigned STEMI patients admitted within 12 h of symptom onset undergoing primary angioplasty and stent implantation to BMS, PES, or SES. The primary study end point was target lesion revascularization at 1-year follow-up. All patients were reviewed at our outpatient clinic or by telephone interview at 6, 12, and 24 months. Results From October 2003 to December 2005, 270 STEMI patients undergoing primary angioplasty were randomized to BMS (n = 90), PES (n = 90), or SES (n = 90). No patient was lost to follow-up. As compared with BMS (14.4%), both PES (4.4%, p = 0.023) and SES (3.3%, p = 0.016) were associated with a significant reduction in target lesion revascularization at 1-year follow-up. At 2-year follow-up no difference was observed in terms of death, reinfarction, and combined death and/or reinfarction, but as compared with BMS, both PES and SES were associated with significant benefits in major adverse cardiac events (PES: 16.7%, p = 0.015; SES: 15.6%, p = 0.009, respectively). Conclusions This study shows that among STEMI patients undergoing primary angioplasty, both SES and PES are safe and associated with significant benefits in terms of target lesion revascularization up to the 2-year follow-up. Thus, until the results of further large randomized trials with long-term follow-up become available, drug-eluting stents may be considered for STEMI patients undergoing primary angioplasty. (PaclitAxel or Sirolimus-Eluting Stent versus Bare Metal Stent in Primary Angioplasty [PASEO] Randomized Trial; NCT00759850 )