One year clinical and six month angiographic results of drug eluting stents for ST elevation acute myocardial infarction: `Real World` comparison between Sirolimus- and Paclitaxel-eluting stents

Abstract

Background: Concerns about safety of drug eluting stents have stirred up controversy on their use in patients with acute STEMI. It is also unknown whether differences in efficacy and safety exist between sirolimus- ( SES) and paclitaxel-eluting stents ( PES). Objective: To investigate the difference in angiographic results and clinical outcome between SES and PES in the treatment of acute STEMI, we analyzed "real world" 6 months angiographic and 1 year clinical outcome of 244 patients, comparing the results between SES and PES. Methods: 244 consecutive acute STEMI patients were analyzed retrospectively ( 185 patients in SES group ( Group S), 59 patients in PES group ( Group P). Immediate post PCI and six month angiographic findings were analyzed by quantitative coronary angiography. Clinical events up to 1 year including cardiovascular death, myocardial infarction, and target lesion revascularization were also analyzed. Results: Baseline clinical and immediate post-procedure angiographic characteristics were similar in the two groups except for mean stent diameter and length which was slightly wider and shorter in group P compared with group S ( Mean stent diameter x length: 3.12 +/- 0.34 x 24.4 +/- 5.1 vs. 3.01 +/- 0.34 x 26.6 +/- 7.2 mm in group P vs. S, p= 0.02, p= 0.03). At six months, late loss was significantly greater in group P compared with group S ( 0.35 +/- 0.62 vs. 0.07 +/- 0.42, p<0.01), although the difference in binary restenosis was not statistically significant. Diameter stenosis, which was similar immediately after PCI, was significantly greater in group P ( 22.0 +/- 17.1 vs. 15.6 +/- 13.4%, p= 0.02). At 1 year, the incidence of stent thrombosis was similar in both groups ( 5.1% vs. 3.8% for group P vs. C). There were no differences between the two groups up to 1 year with regard to cardiovascular death, nonfatal myocardial infarction, and TLR. The free from adverse event rate was not statistically different between the two groups ( 84.2% vs. 90.2%, p= 0.20 for group P vs. C). Conclusion: In this group of Korean acute STEMI patients, SES stent showed lower late loss compared to PES at 6 months angiographic follow up, but there was no difference in clinical outcome up to 1 year. (C) 2007 Elsevier Ireland Ltd. All rights reserved.