Long-term safety and efficacy of second-generation everolimus-eluting stents compared to other limus-eluting stents and bare metal stents in patients with acute coronary syndrome.

ABSTRACT

OBJECTIVES: This study aimed to investigate the long-term safety and efficacy of everolimus-eluting stents (EES) compared with other limus-eluting stents and bare metal stents (BMS) in ACS patients. BACKGROUND: There have been concerns about the long-term safety of drug-eluting stents in the setting of acute coronary syndrome. METHODS: The study cohort included 1,612 patients presenting with acute coronary syndrome who underwent BMS, SES, E-ZES, or EES implantation. End points included probable or definite stent thrombosis and major adverse cardiovascular events (MACE), defined as a composite of all-cause death, Q-wave myocardial infarction, and target lesion revascularization up to 3 years. RESULTS: The overall MACE rates were significantly higher for both BMS and SES, but not E-ZES, when compared with EES (EES vs. BMS HR 2.68, 95% CI 1.91-3.78, P <0.001; EES vs. SES HR 1.75, 95% CI 1.24-2.47, P = 0.001 and EES vs. E-ZES HR 1.08, 95% CI 0.65-1.77, P = 0.72). Stent thrombosis rates were similar for EES, E-ZES, and BMS but higher for SES throughout the 3-year follow-up (EES vs. BMS HR 1.02, 95% CI 0.31-3.35, P = 0.973; EES vs. SES HR 4.90, 95% CI 1.75-13.69, P = 0.002 and EES vs. E-ZES HR 1.63, 95% CI 0.37-7.31, P = 0.449). CONCLUSIONS: There was an improvement in the long-term outcome for MACE with EES when compared to earlier-generation stents, but this was comparable with the 2nd-generation E-ZES. There was no additional risk of early or late stent thrombosis in EES when compared with BMS.