Five-Year Comparative Efficacy of Everolimus-Eluting vs. Resolute Zotarolimus-Eluting Stents in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Abstract

Among drug-eluting stents (DESs), the durable polymer everolimus-eluting stent (EES) and resolute zotarolimus-eluting stent (R-ZES) are widely used in clinical practice and have contributed to improve the outcomes of patients undergoing percutaneous coronary intervention (PCI). Few studies addressed their long-term comparative performance in patients with acute coronary syndrome (ACS). We aimed to investigate the 5 year comparative efficacy of EES and R-ZES in ACS. We queried ACTION-ACS, a large-scale database of ACS patients undergoing PCI. The treatment groups were analyzed using propensity score matching. The primary endpoint was a composite of mortality, myocardial infarction (MI), stroke, repeat PCI, and definite or probable stent thrombosis, which was addressed at the five-year follow-up. A total of 3497 matched patients were analyzed. Compared with R-ZES, a significant reduction in the primary endpoint at 5 years was observed in patients treated with EES (hazard ratio (HR) [95%CI] = 0.62 [0.54–0.71], p < 0.001). By landmark analysis, differences between the two devices emerged after the first year and were maintained thereafter. The individual endpoints of mortality (HR [95%CI] = 0.70 [0.58–0.84], p < 0.01), MI (HR [95%CI] = 0.55 [0.42–0.74], p < 0.001), and repeat PCI (HR [95%CI] = 0.65 [0.53–0.73], p < 0.001) were all significantly lower in the EES-treated patients. Stroke risk did not differ between EES and R-ZES. In ACS, a greater long-term clinical efficacy with EES vs. R-ZES was observed. This difference became significant after the first year of the ACS episode and persisted thereafter.

Magnesium bioresorbable scaffold (Magmaris) versus polymer biodegradable ultrathin drug-eluting stent (Ultimaster) in acute coronary syndrome. Mid-term outcomes (2 years)

“…Data regarding the long-term evaluation of Magmaris BRS are rather sparse and mainly originate from retrospective observational clinical registries [20,[27][28][29]. Based on Advances in Interventional Cardiology 2024; 20, 1 (75) this single-arm evaluation despite all of its methodological shortcomings Magmaris showed favorable long-term safety and clinical performance with acceptable target lesion failure rates (5.2% up to 11%), which is comparable to our findings (5.6%) and analogous to novel DES performance [30][31][32]. Also in our study, we did not note significant differences between the Magmaris and Ultimaster DES in terms of TLF (5.6% vs. 8.0, p = 0.41).…”

Comparison of long-term clinical outcomes among zotarolimus-, everolimus-, and biolimus-eluting stents in acute myocardial infarction patients with renal impairment

“…It was mainly driven by the difference between ZES and EES groups, or between ZES and EES groups. In a comparative study evaluating 5-year efficacy of both EES and Resolute ZES in PCI-treated ACS patients, Resolute ZES demonstrated worse long-term outcomes than EES [ 45 ]. The authors of this study emphasized that the clinical differences between the two stent types were mainly driven by the polymer characteristics, not by the antiproliferative agents.…”

Biodegradable polymer everolimus-eluting stents versus contemporary drug-eluting stents: a systematic review and meta‑analysis

“…Previous RCTs and meta-analyses demonstrated that BP-DES were associated with lower incidence of late ST/VLST compared with either bare metal stents or first generation DES 53 . Furthermore, recent studies have shown lower rates of ST in the newer generation cobalt chromium (CoCr) and PtCr durable polymer (polyvinylidene fluoride) EES than other DP-DES, early BP-DES and bare metal scaffolds 54 , 55 . Eventually, a large sample size RCT of the CoCr EES vs. the Nobori ™ ( Terumo ) BP-DES showed comparable long-term outcomes between both stents 56 .…”