• Michael Maeng, Hans-Henrik Tilsted, Lisette Okkels Jensen, Anne Kaltoft, Henning Kelbæk, Ulrik Abildgaard, Anton B Villadsen, Lars Romer Krusell, Jan Ravkilde, Knud Nørregaard Hansen, Evald Høj Christiansen, Jens Aarøe, Jan Skov Jensen, Steen Dalby Kristensen, Hans Erik Bøtker, Morten Madsen, Per Thayssen, Henrik Toft Sørensen, Leif Thuesen, and Jens Flensted Lassen.
• Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark. maeng@ki.au.dk
• JACC Cardiovasc Interv. 2012 Aug 1;5(8):812-8.

ObjectivesThis study sought to examine the 3-year clinical outcomes in patients treated with the Endeavor (Medtronic, Santa Rosa, California) zotarolimus-eluting stent (ZES) or the Cypher (Cordis, Johnson & Johnson, Warren, New Jersey) sirolimus-eluting stent (SES) in routine clinical practice.BackgroundThe long-term clinical outcome in patients treated with ZES in comparison with SES is unclear.MethodsThe authors randomized 2,332 patients to ZES (n = 1,162) or SES (n = 1,170) implantation. Endpoints included major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction, or target vessel revascularization; the individual endpoints of MACE; and definite stent thrombosis.ResultsAt 3-year follow-up, the MACE rate was higher in patients treated with ZES than in patients treated with SES (148 [12.9%] vs. 116 [10.1%]; hazard ratio [HR]: 1.33, 95% confidence interval [CI]: 1.04 to 1.69; p = 0.022). Target vessel revascularization was more frequent in the ZES group compared with the SES group (103 [9.1%] vs. 76 [6.7%]; HR: 1.40, 95% CI: 1.04 to 1.89; p = 0.025), whereas the occurrence of myocardial infarction (3.8% vs. 3.3%) and cardiac death (2.8% vs. 2.8%) did not differ significantly. Although the rate of definite stent thrombosis was similar at 3-year follow-up (1.1% vs. 1.4%), very late (12 to 36 months) definite stent thrombosis occurred in 0 (0%) patients in the ZES group versus 12 (1.1%) patients in the SES group (p = 0.0005).ConclusionsAlthough the 3-year MACE rate is higher in patients treated with ZES versus SES, our data highlight a late safety problem concerning definite stent thrombosis with the use of SES. This finding underscores the importance of long-term follow-up in head-to-head comparisons of drug-eluting stents. (Randomized Clinical Comparison of the Endeavor and the Cypher Coronary Stents in Non-selected Angina Pectoris Patients [SORT OUT III]; NCT00660478).Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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