Randomized prospective comparison of everolimus-eluting vs. Sirolimus-eluting stents in patients undergoing percutaneous coronary intervention ― 3-year clinical outcomes of the EXCELLENT randomized trial

Kyung Woo Park, Tae Min Rhee, Hyun Jae Kang, Bon Kwon Koo, Hyeon Cheol Gwon, Jung Han Yoon, Do-Sun Lim, In Ho Chae, Kyoo Rok Han, Taehoon Ahn, Myung Ho Jeong, Dong Woon Jeon, Yang Soo Jang, Hyo Soo Kim

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Abstract

Background: Everolimus-eluting stents (EES) have equivalent short-term angiographic and clinical outcomes to sirolimus-eluting stents (SES), but EES may be superior to SES with regard to long-term clinical safety. We report the 3-year clinical outcomes of EES and SES from the prospective EXCELLENT Randomized Trial (NCT00698607). Methods and Results: We randomly assigned 1,443 patients undergoing percutaneous coronary intervention 3:1 to receive EES and SES, respectively. We investigated endpoints including target lesion failure (TLF) and individual clinical outcomes including stent thrombosis (ST) at 3 years. For EES and SES, the TLF rate was 4.82% and 4.12% (risk ratio [RR], 1.16, 95% CI: 0.65–2.06, P=0.62), respectively. Results were similar in other efficacy endpoints including target lesion revascularization. For safety endpoints, rate of all-cause death was significantly lower for EES (1.67%) than SES (3.57%; RR, 0.46; 95% CI: 0.23–0.94, P=0.03), while the incidence of cardiac death or myocardial infarction was numerically lower in EES. On 1-year landmark analysis, rates of all-cause death and major adverse cardiovascular events were significantly lower for EES than SES. Definite or probable ST was numerically 3-fold higher for SES (1.37%) compared with EES (0.46%). Conclusions: EES and SES had similar efficacy with regard to 3-year outcomes in the EXCELLENT trial, while delayed safety events all trended to favor EES.

Original languageEnglish
Pages (from-to)1566-1574
Number of pages9
JournalCirculation Journal
Volume82
Issue number6
DOIs
Publication statusPublished - 2018 Jan 1

Keywords

  • Everolimus
  • Percutaneous coronary intervention
  • Sirolimus
  • Stent

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Park, K. W., Rhee, T. M., Kang, H. J., Koo, B. K., Gwon, H. C., Yoon, J. H., Lim, D-S., Chae, I. H., Han, K. R., Ahn, T., Jeong, M. H., Jeon, D. W., Jang, Y. S., & Kim, H. S. (2018). Randomized prospective comparison of everolimus-eluting vs. Sirolimus-eluting stents in patients undergoing percutaneous coronary intervention ― 3-year clinical outcomes of the EXCELLENT randomized trial. Circulation Journal, 82(6), 1566-1574. https://doi.org/10.1253/circj.CJ-17-0677