Abstract 4596: Efficacy and Safety of Zotarolimus-Eluting Stent versus Sirolimus-Eluting or Paclitaxel-Eluting Stent for Patients With Long Coronary Artery Disease in the ZEST Trial: A Subanalysis of a Randomized Trial
BACKGROUND Outcomes remain relatively unfavorable for stent-based coronary intervention of lesions with long diseased segments. Studies comparing the first-generation sirolimus- and paclitaxel-eluting stents and the next-generation drug-eluting stents for long coronary lesions have been limited.
METHODS Patients receiving stent implantation for long (≥20 mm) coronary lesions were included in our analysis following randomization in ZEST trial comparing the second-generation zotarolimus-eluting stent with the first-generation sirolimus-and paclitaxel-eluting stent in everyday clinical practice. The primary end point was a composite of major adverse cardiac events (death, myocardial infarction [MI], and ischemia-driven target-vessel revascularization [TVR]) at 12 months.
RESULTS Among 2645 enrolled patients, 1420 patients with 1994 long lesions received a zotarolimus (471 patients, 651 lesions), sirolimus (492 patients, 703 lesions), or paclitaxel (457 patients, 640 lesions)-eluting stent. Baseline clinical and angiographic characteristics were similar in the three groups. At 12 months, the zotarolimus-stent group showed similar rates of major adverse cardiac events compared with the sirolimus-stent group (12.3% vs. 9.6%, P=0.17), and fewer rates of events compared with the paclitaxel-stent group (12.3% vs. 17.1%, P=0.04). The 12-moths rate of mortality was significantly higher in the paclitaxel-stent group (zotarolimus- vs. sirolimus- vs. paclitaxel-stent, 0.4% vs. 0.4% vs. 1.8%, respectively, P=0.05). The rate of TVR also significantly differ (zotarolimus- vs. sirolimus- vs. paclitaxel-stent, 4.9% vs. 2.0% vs. 9.4%, respectively, P<0.001). A significant lower rate of stent thrombosis was detected in the sirolimus-stent group (zotarolimus- vs. sirolimus- vs. paclitaxel-stent, 0.8% vs. 0% vs. 1.1%, respectively, P=0.05).
CONCLUSIONS In this large-scale, practical randomized trial, the use of zotarolimus-eluting stents results in similar rates of major adverse cardiac events compared with sirolimus-eluting stents, and in fewer major adverse cardiac events compared with paclitaxel-eluting stents for patients with long coronary artery disease.