Comparison of Outcomes Between Zotarolimus- and Sirolimus-Eluting Stents in Patients With ST-Segment Elevation Acute Myocardial Infarction

• Published in: The American journal of cardiology 2010-03, Vol.105 (6), p.813-818
• Main Authors: Kim, Hyun Kuk, MD, Jeong, Myung Ho, MD, Ahn, Young Keun, MD, Kim, Jong Hyun, MD, Chae, Shung Chull, MD, Kim, Young Jo, MD, Hur, Seung Ho, MD, Seong, In Whan, MD, Hong, Taek Jong, MD, Choi, Dong Hoon, MD, Cho, Myeong Chan, MD, Kim, Chong Jin, MD, Seung, Ki Bae, MD, Chung, Wook Sung, MD, Jang, Yang Soo, MD, Rha, Seung Woon, MD, Bae, Jang Ho, MD, Cho, Jeong Gwan, MD, Park, Seung Jung, MD
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Clinical outcomes; Comparative studies; Coronary Angiography; Coronary heart disease; Coronary Restenosis - diagnostic imaging; Drug-Eluting Stents - adverse effects; Electrocardiography; Female; Glycoproteins; Heart; Heart attacks; Humans; Male; Medical imaging; Medical sciences; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - drug therapy; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Patient safety; Patients; Pharmacology. Drug treatments; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Sirolimus - analogs & derivatives; Stents; Thrombosis - diagnostic imaging
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2009.11.009

Zotarolimus-eluting stents (ZESs) demonstrated greater in-segment late luminal loss and in-segment binary restenosis rates compared to sirolimus-eluting stents (SESs) in several studies. However, no data are available in direct comparison between the clinical outcomes of the 2 stents in unselected patients with ST-segment elevation acute myocardial infarction (STEMI). The aim of the present study was to compare the clinical outcomes of ZESs and SESs in real-world patients with STEMI. A total of 873 patients with STEMI (306 patients in the ZES group and 567 patients in the SES group) were enrolled in a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR) from January 2007 to January 2008. The primary end points were major adverse cardiac events, a composite of all causes of death, myocardial infarction, and target lesion revascularization during a 12-month clinical follow-up. During 1 year of follow-up, the primary end points occurred in 140 patients (16.0%). The use of glycoprotein IIb/IIIa inhibitors and the occurrence of multivessel disease were more common in the SES group. The SES group had a significantly lower incidence of major adverse cardiac events (hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.07 to 2.16, p = 0.02), target lesion revascularization (HR 2.16, 95% CI 1.01 to 4.59, p = 0.046), and target vessel revascularization (HR 2.24, 95% CI 1.18 to 4.24, p = 0.013). However, no significant differences were found in death or myocardial infarction (HR 1.37, 95% CI 0.91 to 2.05, p = 0.129). In conclusion, SESs provided superior angiographic outcomes, translating into better clinical outcomes and negating any change in STEMI patient safety profiles compared to ZESs.