Coronary artery disease
Comparison of the Efficacy and Safety of Zotarolimus-, Sirolimus-, and Paclitaxel-Eluting Stents in Patients With ST-Elevation Myocardial Infarction

https://doi.org/10.1016/j.amjcard.2009.06.059Get rights and content

Drug-eluting stents (DESs) are increasingly used for treatment of acute ST-segment elevation myocardial infarction (STEMI), but there are few comparisons of outcomes of various types of DES. We compared the efficacy and safety of zotarolimus-eluting stents (ZESs), sirolimus-eluting stents (SESs), and paclitaxel-eluting stents (PESs) in primary intervention for STEMI. This multicenter, prospectively randomized ZEST-AMI trial included 328 patients at 12 medical centers who were randomly assigned to ZES (n = 108), SES (n = 110), or PES (n = 110) deployment. The primary end point was major adverse cardiac events (death, MI, and ischemia-driven target vessel revascularization) at 12 months. Secondary end points included the individual components of the primary end point, late loss, angiographic restenosis, and stent thrombosis. Baseline clinical and angiographic characteristics were well matched. In-segment late loss (0.28 ± 0.42 vs 0.46 ± 0.48 vs 0.47 ± 0.50 mm, respectively, p = 0.029) and restenosis rate (2.7% vs 15.9% vs 12.3%, respectively, p = 0.027) at 8 months were lowest in the SES group compared to the ZES and PES groups. At 12 months, cumulative incidence rates of primary end points in the ZES, SES, and PES groups were 11.3%, 8.2%, and 8.2%, respectively (p = 0.834). There were 2 acute (in the SES group) and 5 subacute (2 in the SES group and 3 in the PES group) stent thromboses. Incidence of death, recurrent MI, or ischemia-driven target vessel revascularization did not differ among the 3 groups. In conclusion, despite the difference in restenosis rate, the efficacy and safety of the 3 different DESs showed similar, acceptable results in the treatment of STEMI.

Section snippets

Methods

This prospective single-blind, randomized multicenter trial—the Comparison of the Efficacy and Safety of Zotarolimus-Eluting Stent versus Sirolimus-Eluting Stent versus Paclitaxel-Eluting Stent for Acute Myocardial Infarction Patients (ZEST-AMI) trial—was performed at 12 centers in Korea (http://ClinicalTrials.gov, NCT00422565). Patients were eligible for the trial if they had chest pain >30 minutes, presentation within 12 hours after onset of symptoms, and ST-segment elevation (>1 mm in ≥2

Results

From September 2006 to September 2007, 328 patients with STEMI were enrolled and randomized to the ZES (n = 108), SES (n = 110), and PES (n = 110) groups. Baseline patient characteristics were well matched among the 3 groups except age, use of angiotensin-converting enzyme inhibitors, number of stents per lesion, or maximum inflation pressure (Table 1, Table 2). Mean patient age was 59.6 ± 11.2 years; 82.3% of patients were men, and 25.9% had diabetes mellitus. Mean time from onset of symptoms

Discussion

The major findings of this study are as follows: (1) there was no difference in the overall rate of major adverse cardiac events at 12 months among the ZES, SES, and PES groups; (2) there was a nonsignificant trend in favor of ZESs in the rate of stent thrombosis; (3) SESs were associated with lower late loss and restenosis rates compared to ZESs or PESs; and (4) the rate of ischemia-driven target vessel revascularization was the same among the 3 DESs. Our results are thus in agreement with

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    This study was supported by grants from the Korea Health 21 R&D Project, Ministry of Health & Welfare, Korea (0412-CR02-0704-0001), the CardioVascular Research Foundation, and Asan Institute for Life Science (#2008-217).

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