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LESSON I: Long-term comparison of Everolimus-eluting and Sirolimus-eluting Stents for coronary revascularisation

Cardiovascular Surgery
Interventional Cardiology and Cardiovascular Surgery

Stephan Windecker, FESC
Presenter | see Discussant report Webcasts become available 24h after the presentation
Windecker, Stephan
Open presentation slides

List of Authors:


Background: Everolimus-eluting stents have improved clinical outcome compared with paclitaxel-eluting stents. However, it remains unclear whether there are differences in safety and efficacy between everolimus-eluting and sirolimus-eluting stents during long-term follow-up.

Methods and Results: Consecutive patients undergoing percutaneous coronary intervention with everolimus-eluting (n=1601) or sirolimus-eluting stents (n=1532) between May 2004 and March 2009 were identified. Using propensity score matching, we compared clinical outcome among 1342 pairs of patients treated with everolimus-eluting and sirolimus-eluting stents.
The primary outcome was a composite of death, myocardial infarction and target vessel revascularization. The median follow-up was 1.5 years and results are reported up to 3 years. Hazard ratios comparing everolimus-eluting and sirolimus-eluting stents were calculated using Cox regression analysis. The median duration of prescribed dual antiplatelet therapy was 12 months in both groups. The primary outcome occurred in 14.9% in the everolimus-eluting and 18.0% in the sirolimus-eluting stent group up to 3 years (hazard ratio 0.83, 95% CI 0.68-1.00, P=0.056).
All-cause mortality (6.0% versus 6.5%, P=0.59) was similar, whereas the risks of myocardial infarction (3.3% versus 5.0%, P=0.017), and target vessel revascularization (7.0% versus 9.6%, P=0.039) were lower with everolimus-eluting than sirolimus-eluting stents. Definite (hazard ratio 0.30, 95% interval 0.12-0.75, P=0.01) and definite or probable stent thrombosis (hazard ratio 0.64, 95% CI 0.41-0.98, P=0.041) were less frequent among patients treated with everolimus-eluting stents. The reduced rate of myocardial infarction with everolimus-eluting stents was explained in part by the lower risk of definite stent thrombosis and the corresponding decrease in events associated with stent thrombosis (hazard ratio 0.25, 95% CI 0.08 to 0.75, P=0.013).

Conclusions: The unrestricted use of everolimus-eluting stents appears to be associated with improved clinical long-term outcome compared with sirolimus-eluting stents. Differences in favour of the everolimus-eluting stent are driven in part by a lower risk of myocardial infarction associated with stent thrombosis.

Petr Widimsky, FESC
Discussant | see Presenter abstract Webcasts become available 24h after the presentation
Widimsky, Petr
(Czech Republic)
Open presentation slides


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Hot Line II - Coronary artery disease
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.