Abstract 6003: The Unrestricted Use of Everolimus-Eluting Stents for De-novo coronary lesions: The Xience V Stent Evaluated At Rotterdam Cardiology Hospital (X-SEARCH) Registry
Objectives: Everolimus-eluting stents (EES) have been shown to be effective in the context of randomized trials with selected patients. However, the effect of EES implantation in more complex, unselected patients cannot be directly extrapolated from these findings. We sought to evaluate the impact of this second generation DES in comparison to bare metal, sirolimus-eluting and paclitaxel-eluting stents (BMS, SES and PES respectively) on the short-term clinical outcomes in a real-life all-comer population.
Methods: Since March 2007, our institution commenced the use of EES (Xience V; Abbott Vascular) as the default strategy for every PCI. Between 1st March and 31st October 2007, 649 consecutive patients presenting with de novo lesions were treated exclusively with EES. These patients were compared to 3 historical cohorts of consecutive patients; 450 patients treated with bare metal stents (BMS), 508 with sirolimus-eluting stents (SES) and 576 paclitaxel-eluting stents (PES) from the RESEARCH and T-SEARCH registries. Six month survival data was acquired from municipal civil registries and questionnaires are currently being sent to all living patients to obtain data on adverse clinical events. Medical records will be reviewed and referring cardiologists will be contacted if necessary.
Results: EES patients were significantly older (BMS:61 yrs, SES:61 yrs, PES:62 yrs, EES:64 yrs, p<0.01) and presented more frequently with ST-elevation MI (18% vs. 18% vs. 28% vs. 40%, p<0.0001). Within the first month, there were 50/2163 deaths (2.3%); the mortality rates in the BMS, SES, PES and EES groups were 2.0%, 1.6%, 1.6% and 3.8% respectively (p=0.03). Unadjusted analysis revealed that STEMI was a strong predictor of 30 day mortality (HR 10.7, 95%CI 5.4–21.3). Increasing age was also predictive (HR 1.03, 95%CI 1.00–1.08), whilst treatment with EES was associated with a non-significant trend towards higher 30 day mortality (HR 2.34, 95% CI 0.8 – 6.9). After adjustment for STEMI and age, this trend was less apparent (HR1.3, 95% CI 0.7–2.3).
Conclusion: After 30 days, there were no significant differences in mortality between BMS, SES, PES and EES. Data on 6-month mortality and clinical events are currently being collected and will be presented at the time of the meeting.