Very long-term clinical and angiographic outcomes after sirolimus- and paclitaxel-eluting stent placement for ST-elevati
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ORIGINAL ARTICLE
Very long-term clinical and angiographic outcomes after sirolimus- and paclitaxel-eluting stent placement for ST-elevation myocardial infarction: a propensity score-matched comparison Takashi Miyamoto1 • Tetsuya Ishikawa1 • Yosuke Nakano1 • Makoto Mutoh1
Received: 14 November 2015 / Accepted: 1 March 2016 Japanese Association of Cardiovascular Intervention and Therapeutics 2016
Abstract We conducted a retrospective examination of the very long-term outcomes of placing sirolimus (SES) and paclitaxel (PES)-eluting stents in patients with STelevation myocardial infarction (STEMI). This was a nonrandomized, retrospective, single-center study that included 872 first STEMI patients who underwent successful placement of either SES (n = 547) or PES from November 2004 to April 2012. The primary end point was the incidence of severe cardiac events comprising cardiac death, nonfatal recurrent myocardial infarction, and definite stent thrombosis (ST). The frequency of target lesion revascularization (TLR) was also compared. A propensity score-matched analysis was used to adjust the 29 baseline variables. In the baseline-adjusted cohorts in 231 STEMI patients in each arm, the frequency of the primary end point in the SES group (5.6 %) during the follow-up duration of 2583 ± 806 days was not significantly different from that in the PES group (6.1 %, follow-up: 1866 ± 699 days). The cumulative primary end point-free ratio in the SES group was not significantly different from that in the PES group (p = 0.503). The frequency of TLR in the SES group (7.5 %) was significantly lower than that in the PES group (16.9 %, p = 0.005), with and the significantly higher cumulative TLR-free ratio in the SES group than that in the PES group (p \ 0.001). The very long-term clinical outcomes after SES or PES placement for STEMI patients were statistically equivalent. SES showed the better angiographic outcomes for STEMI compared to PES. & Tetsuya Ishikawa [email protected] 1
Division of Cardiology, Saitama Cardiovascular Respiratory Center, 1696 Itai, Kumagaya, Saitama 360-0197, Japan
Keywords ST-elevation myocardial infarction (STEMI) Sirolimus-eluting stent Paclitaxel-eluting stent Very late stent thrombosis Target lesion revascularization
Introduction The long-term safety and efficacy of sirolimus-eluting stents (SESs; Cypher Bx Velocity; Cordis Corp., Miami, FL, USA) for use in primary stenting in patients with STelevation myocardial infarction (STEMI) in comparison with those of bare-metal stents (BMSs) have been established in Japan [1–4] (Ref. [1]: mean follow-up for SES, 1327 ± 415 days; for BMS, 1818 ± 681 days). In addition, the midterm equivalent clinical safety of SES and paclitaxel-eluting stents (PESs; TAXUS Express and TAXUS Liberte; Boston Scientific, Natick, MA, USA) for use in STEMI patients was also reported [5, 6] (Ref. [6]: mean follow-up period for PES placement, 1170 ± 243 days). However, although more than a decade has passed since the first-generation drug-eluting stents (DESs)
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