Key result
In patients with low-risk coronary artery disease, there was no significant difference in all-cause mortality between those treated with E-ZES (HR 1.14) or EES (HR 0.77) compared to SES.
Why the study?
Does the use of E-ZES or EES improve all-cause mortality compared to SES in patients receiving single stent implantation?
Cohort (n=6,584)
Does the use of E-ZES or EES improve all-cause mortality compared to SES in patients receiving single stent implantation?
In a nationwide real-world cohort, there was no significant difference in all-cause mortality, acute coronary events, heart failure, or cerebrovascular disease among patients treated with sirolimus-, zotarolimus-, or everolimus-eluting stents, though newer generation stents were associated with higher rates of repeat revascularization in the first year.
No mortality difference with E-ZES or EES versus SES in low-risk CAD; leaves open optimal stent selection pending randomized trials.
The clinical outcomes of different limus-based drug-eluting stents (DES) in a real-world setting have not been well defined. The aim of this study was to investigate the clinical outcomes of three different limus-based DES, namely sirolimus-eluting stent (SES), Endeavor zotarolimus-eluting stent (E-ZES) and everolimus-eluting stent (EES), using a national insurance claims database. We identified all patients who received implantation of single SES, E-ZES or EES between January 1, 2007 and December 31, 2009 from the National Health Insurance claims database, Taiwan. Follow-up was through December 31, 2011 for all selected clinical outcomes. The primary end-point was all-cause mortality. Secondary end-points included acute coronary events, heart failure needing hospitalization, and cerebrovascular disease. Cox regression model adjusting for baseline characteristics was used to compare the relative risks of different outcomes among the three different limus-based DES. Totally, 6584 patients were evaluated (n=2142 for SES, n=3445 for E-ZES, and n=997 for EES). After adjusting for baseline characteristics, we found no statistically significant difference in the risk of all-cause mortality in three DES groups (adjusted hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 0.94-1.38, p=0.20 in E-ZES group compared with SES group; adjusted HR: 0.77, 95% CI: 0.54-1.10, p=0.15 in EES group compared with SES group). Similarly, we found no difference in the three stent groups in risks of acute coronary events, heart failure needing hospitalization, and cerebrovascular disease. In conclusion, we observed no difference in all-cause mortality, acute coronary events, heart failure needing hospitalization, and cerebrovascular disease in patients treated with SES, E-ZES, and EES in a real-world population-based setting in Taiwan.
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Lai et al. (2015) conducted a cohort in Low Risk Coronary Artery Disease (n=6,584). Endeavor zotarolimus-eluting stent (E-ZES) or everolimus-eluting stent (EES) vs. Sirolimus-eluting stent (SES) was evaluated on All-cause mortality (HR 1.14 for E-ZES vs SES; HR 0.77 for EES vs SES, 95% CI 0.94-1.38 for E-ZES; 0.54-1.10 for EES, p=0.20 for E-ZES; 0.15 for EES). In patients with low-risk coronary artery disease, there was no significant difference in all-cause mortality between those treated with E-ZES (HR 1.14) or EES (HR 0.77) compared to SES.
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