Comparisons of Everolimus and Paclitaxel-Eluting Stents in Patients with Acute Myocardial Infarction

Abstract

Background: It has been established that the newer-generation drug-eluting stent (DES) everolimus-eluting stent (EES) is superior to the first-generation DES paclitaxel-eluting stent (PES). However, the advantages of EES over PES in the setting of acute myocardial infarction (AMI) need to be fully elucidated. Methods: The present analysis enrolled 2,911 AMI patients receiving PES (n¼1,210) or EES (n¼1,701) in a largescale, prospective, multicenter Korea Acute Myocardial Infarction Registry (KAMIR). Propensity score matching was used to adjust for baseline biases in clinical and angiographic characteristics, yielding a total of 2,398 patients (1,199 receiving PES and 1,199 receiving EES). Various clinical outcomes at 1 year were compared between the two propensity score matched groups. Target lesion failure (TLF) was defined as the composite of cardiac death, recurrent nonfatal myocardial infarction (Re-MI), or target lesion revascularization (TLR). Results: Baseline clinical and angiographic characteristics were comparable between the two groups after propensity score matching. Clinical outcomes of the propensity score matched patients showed that the rates of inhospital and 1-year cardiac and all-cause death were similar between the two groups. But patients in the EES group had significantly lower incidences of Re-MI (1.4% vs 2.8%, P¼0.002), TLR (1.2% vs 3.1%, P¼0.001), TLF (6.4% vs 10.2%, P¼0.001), and probable or definite stent thrombosis (0.3% vs 1.8%, P<0.001) than did those in the PES group. Conclusions: The present propensity matched analysis suggests that the use of EES in the setting of AMI appears to be superior to PES in reducing TLF, and stent thrombosis.