The authors explain that because the risk of stent thrombosis is higher in ACS patients than stable patients, the use of early drug-eluting stents (DES) has been debated. In fact, “ACS still constitutes an off-label indication for the use of these devices according to the U.S. Food and Drug Administration.”
However, newer everolimus-eluting stents aim to improve upon the safety profile of earlier devices, they continue. EES have been shown to be better than paclitaxel-eluting stents, but less clearly so for sirolimus eluting stents (SES).
The current observational study assessed long-term clinical outcomes in 1746 consecutive ACS patients; 903 were treated with everolimus-eluting stents while 843 received sirolimus eluting stents.
Propensity-score matching produced 705 matched pairs from the two arms. In this cohort, the 3-year rate of death, MI and target vessel revascularization (the composite endpoint) was 13.8% in the EES group versus 17.7% in the SES-treated patients (hazard ratio 0.72; p=0.02), the investigators report.
This difference was driven mainly by a lower likelihood of target vessel revascularization with EES (5.7%) than SES (8.8%), reflecting the difference in occurrence of definite or probable stent thrombosis (3.4% vs 6.1%), the authors found.
Dr. Windecker and colleagues say the clinical implications are two-fold. “First, DES efficacy in ACS patients can be further advanced beyond the level of the previous gold standard of SES without compromising, but rather even improving, their safety profile. Second, EES appear to be associated with a lower propensity for ST (stent thrombosis) as compared with SES among ACS patients.”
They add, “The latter may have important implications for the duration of dual antiplatelet therapy.”
JACC: Cardiovascular Interventions, 2012;5:145–154.