Long-Term Safety and Efficacy of Sirolimus- and Paclitaxel-Eluting Stents in Patients With Acute Myocardial Infarction: Four-Year Observational Study

Background and Objectives: The comparison of long-term clinical effects between Sirolimus-eluting stent (SES) and Paclitaxel-eluting stents (PES) for treatment of acute myocardial infarction (AMI) remains unclear. Seeking to clarify this issue, we performed a retrospective analysis to evaluate four-year clinical outcomes of SES compared to PES treated AMI patients. Subjects and Methods: From January 2004 to August 2006, all patients with acute ST-segment elevation myocardial infarction and acute non-ST segment elevation myocardial infarction who underwent percutaneous coronary intervention (PCI) by implantation of either SES or PES were enrolled. The occurrences of cardiac and non-cardiac deaths, recurrent infarction, target vessel revascularization (TVR) and stent thrombosis were analyzed. The composite end points of these major adverse cardiac events (MACE) were also analyzed. Results: During the study period, a total of 668 AMI patients had visited, of which 522 patients (299 with SES and 223 with PES) were enrolled. During the four-year clinical follow-up, both groups showed similar occurrences of non-cardiac death ($14.6{\pm}2.2$% vs. $18.3{\pm}3.0$%, p=0.26); cardiac death ($6.8{\pm}1.52$% vs. $11.2{\pm}2.6$%, p=0.39); re-infarction ($3.3{\pm}1.1$% vs. $6.4{\pm}1.8$%, p=0.31); and stent thrombosis ($3.2{\pm}1.1$% vs. $5.4{\pm}1.7$%, p=0.53). However, occurrences of TVR {$4.0{\pm}1.2$% vs. $10.0{\pm}3.0$%, hazard ratio (HR)=0.498, 95% confidence interval (CI)= 0.257-0.967, p=0.039} and MACE ($19.4{\pm}2.5$% vs. $29.4{\pm}3.5$%, HR=0.645, 95% CI=0.443-0.940, p=0.021) were significantly lower in the SES population.