Key result
Zotarolimus- and everolimus-eluting stents show no significant difference in TVF vs. sirolimus-eluting stents at 2 years.
Why the study?
Contemporary drug-eluting stents differ in multiple technical characteristics, leaving the independent association between the eluted limus drug and clinical outcomes uncertain.
Does the type of eluted limus agent (zotarolimus or everolimus vs sirolimus) reduce target vessel failure in patients undergoing PCI?
Cohort (n=1,940)
No
Does the type of eluted limus agent (zotarolimus or everolimus vs sirolimus) reduce target vessel failure in patients undergoing PCI?
Hazard Ratio: 1.38 (95% CI 0.74–2.58)
Absolute Event Rate: 7.7% vs 5.4%
p-value: p=0.458
The antiproliferative drug category (sirolimus, zotarolimus, or everolimus) is not a major independent determinant of mid-term clinical outcomes in contemporary PCI practice.
No difference in target vessel failure by limus agent should not yet change stent selection; leaves open confirmation in randomized PCI trials.
Background/Objectives: Contemporary drug-eluting stents (DES) differ in antiproliferative drug, strut geometry, polymer, alloy, and drug release kinetics, and the independent association between the eluted drug and clinical outcomes remains uncertain. We compared outcomes among contemporary sirolimus-, zotarolimus-, and everolimus-eluting stents. Methods: This single-center retrospective cohort included 1940 patients who underwent percutaneous coronary intervention (PCI) between 2012 and 2021 with sirolimus- (n = 537), zotarolimus- (n = 400), or everolimus-eluting stents (n = 1003). The primary endpoint was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction (MI), or target vessel revascularization (TVR). The secondary endpoint was major adverse cardiovascular events (MACE), a composite of all-cause death, MI, or any revascularization. Stabilized inverse probability of treatment weighting (IPTW) based on pretreatment covariates and PCI era was used to address baseline and temporal differences; follow-up was censored at two years. Results: During a median follow-up of 731 days, weighted TVF rates were 5.4%, 7.7%, and 6.5% in the sirolimus, zotarolimus, and everolimus groups, respectively. Compared with sirolimus, TVF did not differ with zotarolimus (hazard ratio [HR] 1.38; 95% confidence interval [CI] 0.74–2.58) or everolimus (HR 1.19; 95% CI 0.70–2.02; overall p = 0.458). MACE also did not differ (overall p = 0.517). In complex PCI, TVF was higher with zotarolimus and everolimus than with sirolimus; however, event counts were small and the analyses were exploratory. Conclusions: In this observational cohort, no significant differences in mid-term outcomes were observed among the three drug-defined groups. Because drug type is closely intertwined with stent platform design, these findings should not be extrapolated to individual stent platforms. The exploratory complex-PCI subgroup finding requires confirmation in larger studies.
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Joo et al. (2026) conducted a cohort in Patients undergoing percutaneous coronary intervention (PCI) (n=1,940). Zotarolimus- or everolimus-eluting stents vs. Sirolimus-eluting stents was evaluated on Target vessel failure (composite of cardiac death, target vessel MI, or target vessel revascularization) (HR 1.38, 95% CI 0.74-2.58, p=0.458). Compared with sirolimus-eluting stents, the risk of target vessel failure did not differ significantly with zotarolimus-eluting stents (HR 1.38) or everolimus-eluting stents (HR 1.19) at 2 years.
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