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ȣ - 540278 37 |
Comparison of zotarolimus-eluting stents versus sirolimus-eluting stents and paclitaxel-eluting stents for diffuse very long lesions; A Subgroup Analysis of the ZEST 2-year follow-up |
울산대학교 서울아산병원 |
황기원, 이종영, 김원장, 박덕우, 강수진, 이승환, 김영학, 이철환, 박성욱 |
Background Although drug-eluting stents (DES) has shown to be effective in angiographic restenosis, percutaneous coronary intervention (PCI) of long coronary lesions are still challenging and limited for the long-term experience in the current era.
Methods We performed subgroup analysis of patients with very long coronary lesions (lesion length ≥ 28 mm) in the ZEST trial comparing second-generation zotarolimus-eluting stents with first-generation sirolimus- and paclitaxel-eluting stents. The primary end point was composite major adverse cardiac events (MACE) of death, myocardial infarction (MI), or ischemic-driven target vessel revascularization (TVR).
Results A total of 960 patients with very long coronary lesions were treated with zotarolimus- (ZES, 322 patients), sirolimus- (SES, 317 patients), or paclitaxel-eluting stents (PES, 321 patients). All patients with very long lesions were available for 2-year clinical follow-up. At 24 months, the zotarolimus-stent group showed similar rates of MACE compared with the paclitaxel-stent group (16.1% vs. 17.4, P=0.58), but trend toward higher rates of events compared with the sirolimus-stent group (16.0% vs. 11.0%, p=0.059). Theses difference were mainly driven by TVR (SES vs. ZES, p=0.059; ZES vs. PES, p=0.37; SES vs. PES, p=0.006). There was no significant difference of death or MI among the groups.
Conclusion For patients with very long coronary artery disease, PCI with ZES results in similar rates of MACE compared with PES, but in trend toward higher rates of MACE compared with SES at 2-year.
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Table 1. Major adverse clinical events at 2 years
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ZES
(n= 322) |
SES
(n=317) |
PES
(n=321) |
Log-rank p |
Death |
3 (0.9%) |
4 (1.3%) |
6 (1.9%) |
0.57 |
Cardiac |
3 (0.9%) |
3 (0.9%) |
5 (1.6%) |
0.69 |
Noncardiac |
1 (0.3%) |
1 (0.3%) |
1 (0.3%) |
0.83 |
Myocardial infarction |
31 (9.6%) |
24 (7.6%) |
31 (9.7%) |
0.57 |
Q-wave |
2 (0.6%) |
1 (0.3%) |
4 (1.2%) |
0.37 |
Non Q-wave |
29 (9.0%) |
24 (7.6%) |
27 (8.4%) |
0.80 |
Stent thrombosis |
|
|
|
|
Definite |
0 |
0 |
3 (0.9%) |
0.049 |
Definite/probable |
1 (0.3%) |
0 |
4 (1.2%) |
|
Ischemic-driven TLR |
22 (6.8%) |
9 (2.8%) |
28 (8.7%) |
0.006* |
Ischemic-driven TVR |
23 (7.1%) |
12 (3.8%) |
29 (9.0%) |
0.024† |
MACE |
52 (16.1%) |
35 (11.0%) |
56 (17.4%) |
0.059‡ |
MACE indicates major adverse cardiac events, death, myocardial infarction (MI), or ischemic-driven target vessel revascularization (TVR); TLR, target lesion revascularization; ARC, Academic Research Consortium.
*p=0.018 for ZES vs SES; p=0.36 for ZES vs PES; p=0.001 for SES vs PES, †p=0.059 for ZES vs SES; p=0.37 for ZES vs PES; p=0.006 for SES vs PES ‡ p=0.021 for SES vs PES
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