TCT-27 Comparison of Novel Zotarolimus-Eluting Cobalt-Chromium Stents and Everolimus-Eluting Platinum-Chromium Stents in Patients of the Randomized DUTCH PEERS Trial Presenting with Acute Myocardial Infarction

Abstract

Background: Biocompatible durable polymer coatings for drug-eluting stents (DES) were developed to reduce the risk of stent thrombosis, which is generally increased in the setting of acute myocardial infarction (MI). These coatings are used on novel, flexible, and highly deliverable third-generation DES, investigated in the randomized, multicenter, all-comer DUTCH PEERS (TWENTE II) trial. Of the 1,811 eligible all-comer patients of DUTCH PEERS, 817 (45%) were treated in the setting of acute MI. Methods: We assessed the one-year safety and efficacy of the Resolute Integrity zotarolimus-eluting stent (ZES) (Medtronic, Santa Rosa, CA, USA) and Promus Element everolimus-eluting stent (EES) (Boston Scientific, Natick, MA, USA) in 817 DUTCH PEERS patients who were treated for acute MI. One-year follow-up data of all patients were obtained; adverse events were externally adjudicated by an independent committee. The primary endpoint was target vessel failure (TVF) at 1-year, a composite of cardiac death, target vessel related MI, and clinically indicated target vessel revascularization. Secondary endpoints included all the individual components of the primary endpoint, the incidence of stent thrombosis (ST), and the patient-oriented clinical endpoint (POCE). Results: Patient and lesion characteristics did not differ between groups with the only exception being higher proportions of severely calcified lesions (87/548(16%) vs. 108/500(22%), p=0.02) and stent postdilatation in EES (402/548 (73%) vs. 400/500 (80%), p=0.01). At one year, TVF did not differ significantly between the two stent arms (20/421(5%) vs. 15/396 (4%, p=0.50). In addition, POCE was 8% (32/421) for ZES and 6% (23/396) for EES (p=0.31). Definite-or-probable ST rates were very low and similar in both groups (2/421 (0.5%) vs. 1/396 (0.3%), p=1.00). Conclusions: One-year follow-up of DUTCH PEERS patients, who were treated for acute MI, demonstrated excellent clinical results with a similar and sustained safety and efficacy of the Resolute Integrity ZES and the Promus Element EES.