Mid-Term Clinical Outcomes of ACS and Non-ACS Patients Treated With Everolimus-Eluting Stents

Abstract

SummaryDrug-eluting stents (DES) have proven to be effective for reducing the rate of restenosis, whereas stent thrombosis (ST) after DES implantation has raised safety concerns. Everolimus-eluting stents (EES) are a new generation of DES that have demonstrated safety and efficacy compared with first-generation DES. However, the use of EES in patients presenting with acute coronary syndrome (ACS) has not been adequately investigated. We compared the clinical outcomes between the ACS and non-ACS groups treated with EES. A total of 335 consecutive patients who received EES implantation between January 2010 and January 2011 were investigated (ACS; n = 172, non-ACS; n = 163). Clinical outcome data were obtained for 94.3% of the patients. Follow-up angiography was performed in 58.5% of all patients. The median follow-up period was 8 months in both groups. Clinical outcomes were not statistically different between the groups. The rate of target lesion revascularization (TLR) was 2.5% in the ACS group and 3.8% in the non-ACS group (P = 0.37). MACE occurred in 8.2% of the ACS group and 10.2% of the non-ACS group (P = 0.54). A definite ST was identified in one patient in each group (P = 0.75). The unadjusted cumulative event rates estimated by the Kaplan-Meier method and the log-rank test showed no significant difference between the groups for TLR, target vessel revascularization (TVR), all-cause death, or MACE. In conclusion, EES was safe and efficacious for patients presenting with ACS, as well as for those with non-ACS during a mid-term follow-up period. (Int Heart J 2012; 53: 215-220) Key words: Everolimus-eluting stents, Acute coronary syndrome, Stent thrombosis P ercutaneous coronary intervention (PCI) is an established strategy in patients with coronary artery diseases, including acute coronary syndrome (ACS) and non-ACS. 1,2)Drug-eluting stents (DES) have proven to be effective for reducing the rate of restenosis in patients receiving PCI, [3][4][5][6][7] while in contrast safety concerns have been raised for late or very late stent thrombosis (ST) after DES implantation. 8,9) Everolimus-eluting stents (EES; Xience V, Abbott Vascular, Santa Clara, CA, USA and Promus; Boston Scientific, Natick, MA, USA) are a new generation of DES that have demonstrated safety and efficacy compared with first-generation DES in several clinical trials and are widely used in clinical practice. [10][11][12][13] The use of DES is recommended for primary PCI in the setting of ACS in the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 1) However, the DES used in the previous clinical trials supporting the guideline were sirolimus-eluting stents (SES) or paclitaxel-eluting stents (PES).14-17) Therefore, whether EES demonstrates safety and efficacy in the setting of ACS is of interest. We studied the clinical outcomes in patients treated with EES, and compared the outcomes between the ACS and non-ACS groups.