Key result
Sirolimus-eluting stents significantly reduced the four-year risk of major adverse cardiac events by 35.5% (HR 0.645) compared to paclitaxel-eluting stents in patients with acute myocardial infarction.
Why the study?
Does sirolimus-eluting stent implantation reduce major adverse cardiac events compared to paclitaxel-eluting stents in patients with acute myocardial infarction?
Observational (n=522)
No
Does sirolimus-eluting stent implantation reduce major adverse cardiac events compared to paclitaxel-eluting stents in patients with acute myocardial infarction?
Hazard Ratio: 0.645 (95% CI 0.443–0.94)
Absolute Event Rate: 19.4% vs 29.4%
p-value: p=0.021
In patients with acute myocardial infarction, sirolimus-eluting stents significantly reduced the 4-year risk of target vessel revascularization and MACE compared to paclitaxel-eluting stents.
May favor sirolimus-eluting stents in AMI; leaves open need for randomized confirmation before practice change.
BACKGROUND AND OBJECTIVES: The comparison of long-term clinical effects between Sirolimus-eluting stent (SES) and Paclitaxel-eluting stents (PES) for treatment of acute myocardial infarction (AMI) remains unclear. Seeking to clarify this issue, we performed a retrospective analysis to evaluate four-year clinical outcomes of SES compared to PES treated AMI patients. SUBJECTS AND METHODS: From January 2004 to August 2006, all patients with acute ST-segment elevation myocardial infarction and acute non-ST segment elevation myocardial infarction who underwent percutaneous coronary intervention (PCI) by implantation of either SES or PES were enrolled. The occurrences of cardiac and non-cardiac deaths, recurrent infarction, target vessel revascularization (TVR) and stent thrombosis were analyzed. The composite end points of these major adverse cardiac events (MACE) were also analyzed. RESULTS: During the study period, a total of 668 AMI patients had visited, of which 522 patients (299 with SES and 223 with PES) were enrolled. During the four-year clinical follow-up, both groups showed similar occurrences of non-cardiac death (14.6±2.2% vs. 18.3±3.0%, p=0.26); cardiac death (6.8±1.52% vs. 11.2±2.6%, p=0.39); re-infarction (3.3±1.1% vs. 6.4±1.8%, p=0.31); and stent thrombosis (3.2±1.1% vs. 5.4±1.7%, p=0.53). However, occurrences of TVR {4.0±1.2% vs. 10.0±3.0%, hazard ratio (HR)=0.498, 95% confidence interval (CI)=0.257-0.967, p=0.039} and MACE (19.4±2.5% vs. 29.4±3.5%, HR=0.645, 95% CI=0.443-0.940, p=0.021) were significantly lower in the SES population. CONCLUSION: In AMI patients treated with either SES or PES implantation, the former had a significantly lower risk of TVR and MACE during four-year clinical follow-up. Rates of death, cardiac death or recurrent infarction, and stent thrombosis were similar.
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Min et al. (2012) conducted an observational in Acute Myocardial Infarction (n=522). Sirolimus-eluting stent (SES) vs. Paclitaxel-eluting stent (PES) was evaluated on Major adverse cardiac events (MACE) (HR 0.645, 95% CI 0.443-0.940, p=0.021). Sirolimus-eluting stents significantly reduced the four-year risk of major adverse cardiac events by 35.5% (HR 0.645) compared to paclitaxel-eluting stents in patients with acute myocardial infarction.
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