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Clinical research

Comparison of zotarolimus-eluting stents versus sirolimus-eluting stents versus paclitaxel-eluting stents for primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction: results from the Korean Multicentre Endeavor (KOMER) acute myocardial infarction (AMI) trial

1. Gil Hospital, Gachon University of Medicine and Science, Incheon, Republic of Korea; 2. Chonnam National University Hospital, Gwangju, Republic of Korea; 3. Wonju Christian Hospital, Wonju, Republic of Korea; 4. Yeungnam University Hospital, Daegu, Republic of Korea; 5. Konyang University Hospital, Daejeon, Republic of Korea; 6. Keimyung University Dongsan Medical Center, Daegu, Republic of Korea; 7. Korea University Guro Hospital, Seoul, Republic of Korea; 8. Wonkwang University Hospital, Iksan, Republic of Korea; 9. Inje University Busan Paik Hospital, Busan, Republic of Korea; 10. Severance Hospital, Seoul, Republic of Korea; 11. Eulji Hospital, Seoul, Republic of Korea; 12. Inje University Sanggye Paik Hospital, Seoul, Republic of Korea

Aims: The aim of this study was to compare the efficacy and safety of zotarolimus-eluting stents (ZES), sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

Methods and results: This study was a prospective, single-blind, multicentre, randomised trial. The primary endpoint was major adverse cardiac events (MACE) at 12 months post-procedure, defined as cardiac death, recurrent myocardial infarction (MI), or ischaemia-driven target lesion revascularisation (TLR). An angiographic substudy was performed at nine months among 348 patients. From October 2006 to April 2008, 611 patients with STEMI undergoing primary PCI were randomly assigned to treatment with ZES (n=205), SES (n=204), or PES (n=202). The cumulative incidence of MACE was 5.9% in the ZES group, 3.4% in the SES group and 5.7% in the PES group at 12-month follow-up (p=0.457). There was a trend towards a lower rate of ischaemia-driven TLR at 12- (p=0.092) and 18-month (p=0.080) follow-up in the SES group compared to the ZES and PES groups. No difference was observed in rates of cardiac death, recurrent MI and combined death and/or recurrent MI among three groups at 12- and 18-month follow-up. The rate of stent thrombosis was similar among the three groups (2.0% in each group, p=1.000).

Conclusions: As compared with SES and PES, the use of ZES in patients with STEMI undergoing primary PCI, showed similar rates of MACE, cardiac death and recurrent MI at 12 and 18 months. There was a trend towards a higher rate of TLR with ZES or PES compared to SES.

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