• Vol. 41 No. 6, 252–257
  • 15 June 2012

Medium to Long-Term Clinical Outcomes with Everolimus-Eluting Stents in Real-Life Percutaneous Coronary Intervention

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ABSTRACT

Introduction: Everolimus eluting stents (EES) have demonstrated excellent re-stenosis and thrombosis rates in a number of randomised controlled trials. This study reported the real world experience in a single tertiary centre with EES in predominantly acute coronary syndrome (ACS) patients and compared the outcomes in small and large vessels. We measured the medium to long-term major adverse cardiovascular events (MACE) defi ned as all-cause mortality, myocardial infarction (MI) and target vessel revascularisation (TVR) and stent thrombosis.

Materials and Methods: All consecutive patients underwent percutaneous coronary intervention (PCI) with EES (PROMUSTM, Boston Scientifi c, Natick USA; XIENCE VTM, Abbott Vascular, Santa Clara USA) between March 2007 and September 2009 recorded in our coronary intervention registry were included in this study. All patients were advised to stay on dual antiplatelet therapy with Aspirin 100 mg/day and Clopidogrel 75 mg/day. All patients had at least 6 months of clopidogrel, government funded and a further 6 months required self funding.

Results: Four hundred and six consecutive patients received EES during the study period; 403 were included in this study and 3 were lost to follow-up. Indications for PCI were stable angina in 11% of the patients, unstable angina in 38%, non-ST elevation myocardial infarction in 43%, and ST-elevation myocardial infarction in 8%. Procedural success was achieved in 99.5% of the cases. During a median follow-up of 23 months, 3% of the patients had an MI, 3% underwent TVR, 5% all-cause mortality and 2 (0.5%) cases of definite or probable stent thrombosis. The Kaplan Meier 2-year survival and MACE free survival were 95% and 89% respectively. A subgroup analysis comparing MACE in patients who were treated with a single small (≤2.75 mm; n = 91) or large (≥3 mm; n = 118). EES did not show significant difference during the 2-year follow-up (12% vs 9%; P = 0.34).

Conclusion: Everolimus eluting stent appears to be safe in a real world setting with satisfactory median-term outcomes which include low rates of TVR and other adverse events. EES appear to be equally effective in both small and large vessels.


Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has demonstrated improved clinical outcomes compared with bare-metal stents (BMS) in many randomised controlled trials and observational registries. The improved outcome is mainly limited to reduced clinical and angiographic restenosis without significant reduction in cardiovascular mortality or myocardial infarction. The second generation DES everolimus-eluting stents (EES) in many recent large-scale trials have demonstrated superior clinical outcomes and safety when compared with paclitaxel-eluting stents. In this study, we investigate the real world outcomes of EES in a single, high volume tertiary centre and compare the results of EES in small and large vessels. We measured the medium to long-term major adverse cardiovascular events (MACE) defined as all-cause mortality, myocardial infarction (MI) and target vessel revascularisation (TVR) and stent thrombosis.

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