Three-Year Outcomes Following Sirolimus - Versus Paclitaxel -Eluting Stent Implantation in an Unselected Population With Coronary Artery Disease (from the REWARDS Registry)

The Registry Experience at the Washington Hospital Center with Drug-Eluting Stents (REWARDS) study includes unselected patients with coronary artery disease treated with sirolimus-eluting stents (SESs; n = 2,392) or paclitaxel-eluting stents (PES; n = 1,119). This study aimed to examine the long-ter...

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Veröffentlicht in:The American journal of cardiology 2010-08, Vol.106 (4), p.504-510
Hauptverfasser: Hanna, Nicholas N., MD, Gaglia, Michael A., MD, MSc, Torguson, Rebecca, MPH, Ben-Dor, Itsik, MD, Gonzalez, Manuel A., MD, MPH, Collins, Sara D., MD, Syed, Asmir I., MD, Maluenda, Gabriel, MD, Kaneshige, Kimberly, BS, Xue, Zhenyi, MS, Satler, Lowell F., MD, Kent, Kenneth M., MD, PhD, Suddath, William O., MD, Pichard, Augusto D., MD, Waksman, Ron, MD
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Sprache:eng
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Zusammenfassung:The Registry Experience at the Washington Hospital Center with Drug-Eluting Stents (REWARDS) study includes unselected patients with coronary artery disease treated with sirolimus-eluting stents (SESs; n = 2,392) or paclitaxel-eluting stents (PES; n = 1,119). This study aimed to examine the long-term safety profile of the 2 stents in a “real-world” population, especially in relation to stent thrombosis, and to compare differences in the diabetic cohort. Patients were followed for 3 years with regard to major adverse cardiac events (MACEs), including death, Q-wave myocardial infarction, and target lesion revascularization. Rates of stent thrombosis were also studied. Baseline characteristics were similar between stents. Although MACE rates at 3 years were similar (SES 28.1% vs PES 28.9%, p = 0.62), there was a significant difference in unadjusted rates of target lesion revascularization (SES 15.6% vs PES 12.6%, p = 0.03), death (SES 15.7% vs PES 19.0%, p = 0.02), and Q-wave myocardial infarction (SES 0.8% vs PES 2.1%, p = 0.003). After multivariable Cox regression to adjust for confounders, there was no significant difference in overall MACEs. Incidence of stent thrombosis was higher in the SES group (SES 2.2% vs PES 1.6%, p = 0.22), but this was not statistically significant (hazard ratio 1.6, 95% confidence interval 0.8 to 2.9, p = 0.17). Overall, diabetics had a higher MACE rate, but there was no difference between insulin- and noninsulin-dependent diabetics. In conclusion, at 3 years, PES and SES achieved similar results in MACEs and stent thrombosis. This should foster confidence that SES or PES can be compared to second-generation drug-eluting stents without concerns for safety or efficacy.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2010.04.001