Efficacy of everolimus-eluting stent implantation in patients with small coronary arteries (≤2.5 mm): outcomes of 3-year clinical follow-up

• Published in: Heart and vessels Vol. 32; no. 7; pp. 796 - 803
• Main Authors: Yano, Hideki, Horinaka, Shigeo, Ishikawa, Mayuko, Ishimitsu, Toshihiko
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-07-2017; Springer Nature B.V
• Subjects: Aged; Arteries; Biomedical Engineering and Bioengineering; Cardiac Surgery; Cardiology; Coronary artery; Coronary Artery Disease - therapy; Coronary Restenosis - therapy; Coronary Thrombosis - epidemiology; Coronary Vessels - pathology; Drug delivery; Drug-Eluting Stents - adverse effects; Everolimus - administration & dosage; Female; Follow-Up Studies; Heart; Humans; Implantation; Implants; Intervention; Ischemia; Japan; Kaplan-Meier Estimate; Lesions; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Myocardial infarction; Myocardial Revascularization; Original Article; Patients; Percutaneous Coronary Intervention; Rapamycin; Regression Analysis; Retrospective Studies; Risk Factors; Sirolimus - administration & dosage; Stents; Surgical implants; Thromboembolism; Thrombosis; Treatment Outcome; Vascular Surgery; Sirolimus-eluting stent; Major adverse cardiac events; Stent thrombosis; Everolimus-eluting stent; Small coronary vessel lesions
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-016-0937-4

Previous studies have demonstrated that patients with small coronary artery lesions are at increased risk for late cardiac events after percutaneous coronary intervention. It remains uncertain whether second-generation drug-eluting stents have an advantage over first-generation drug-eluting stents in patients with small vessel lesions. Our aim was to compare in the 3-year clinical impact between second-generation everolimus-eluting stents (EES) and first-generation sirolimus-eluting stents (SES) in small vessel lesions. Four-hundred forty-four patients with small vessel lesions defined as reference diameter <2.5 mm were treated with EES (237 patients, 265 lesions) or SES (207 patients, 220 lesions) and completed 3-year follow-up. We compared the major adverse clinical events (MACE) between the two groups. EES had no significant impact on the MACE rate compared with SES (4.6 vs. 7.2%,
p
 = 0.14). No significant differences were observed in the individual components of cardiac death (1.7 vs. 1.9%,
p
 = 0.78), myocardial infarction (1.3 vs. 3.4%,
p
 = 0.12), and ischemia-driven target lesion revascularization (2.3 vs. 4.6%,
p
 = 0.13) in EES and SES, respectively. Stent thrombosis, however, was significantly less in the EES group than in the SES group (0.7 vs. 3.4%, HR: 0.53, 95% CI 0.38–0.88,
p
 < 0.05). EES implantation did not significantly impact 3-year MACE rates compared to SES implantation in small vessel lesions. A significant reduction in the overall rate of stent thrombosis was observed in recipients of EES. While the SES group showed increasing rates of late and very late thrombosis, the EES group did not. EES offers a safe and effective treatment for small vessel lesions.