Author + information
- Received February 26, 2009
- Revision received April 6, 2009
- Accepted May 13, 2009
- Published online July 14, 2009.
- Yoshinobu Onuma, MD,
- Neville Kukreja, MA, MRCP,
- Nicolo Piazza, MD,
- Jannet Eindhoven, MSc,
- Chrysafios Girasis, MD,
- Lisanne Schenkeveld, MSc,
- Ron van Domburg, PhD,
- Patrick W. Serruys, MD, PhD⁎ (, )
- Interventional Cardiologists of the Thoraxcenter (2000 to 2007)
- ↵⁎Reprint requests and correspondence:
Dr. Patrick W. Serruys, Thoraxcenter, Ba-583, 's Gravendijkwal 230, Rotterdam 3015 CE, the Netherlands
Objectives The purpose of this study was to investigate the impact of everolimus-eluting stents (EES) in comparison with bare-metal stents (BMS), sirolimus-eluting stents (SES), and paclitaxel-eluting stents (PES) on the 6-month clinical outcomes in an all-comer population.
Background EES have been shown to be effective in the context of randomized trials with selected patients. The effect of EES implantation in more complex, unselected patients cannot be directly extrapolated from these findings.
Methods In total, 649 consecutive unselected patients treated exclusively with EES were enrolled. Six-month clinical end points were compared with 3 historical cohorts (BMS, n = 450; SES, n = 508; and PES, n = 576). Major adverse cardiac events (MACE) were defined as a composite of all-cause mortality, myocardial infarction, or target vessel revascularization (TVR).
Results The patients treated with EES were older, presented more frequently with acute myocardial infarction, and had more complicated lesions than the other groups. The EES group demonstrated a higher incidence of all-cause mortality than the SES group and a lower incidence of TVR than the BMS group. Multivariate adjustment demonstrated that BMS was associated with higher TVR and MACE risk than EES (adjusted hazard ratio [HR] for TVR: 2.02 [95% confidence interval (CI): 1.11 to 3.67]; adjusted HR for MACE: 2.15 [95% CI: 1.36 to 3.42]); that SES had a clinical outcome similar to that of EES, and that PES had a higher risk of MACE than did EES (adjusted HR: 1.57 [95% CI: 1.02 to 2.44]).
Conclusions This study suggests that the use of EES in an unselected population may be as safe as and more effective than BMS, may be as safe and effective as SES, may be as safe as PES, and may be more effective than PES.
- Received February 26, 2009.
- Revision received April 6, 2009.
- Accepted May 13, 2009.
- American College of Cardiology Foundation