The Impact of Patient and Lesion Complexity on Clinical and Angiographic Outcomes After Revascularization With Zotarolimus- and Everolimus-Eluting Stents A Substudy of the RESOLUTE All Comers Trial (A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention)

GG Stefanini, PWJC (Patrick) Serruys, S Silber, AA Khattab, Robert Jan van Geuns, G Richardt, PE Buszman, H Kelbaek, AJ van Boven, SH (Sjoerd) Hofma, A Linke, V Klauss, W (William) Wijns, C macaya, P Garot, C (Carlo) di Mario, G Manoharan, R Kornowski, T Ischinger, AL BartorelliP Gobbens, S Windecker

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Abstract

Objectives The aim of this study was to investigate the impact of patient and lesion complexity on outcomes with newer-generation zotarolimus-eluting stents (ZES) and everolimus-eluting stents (EES). Background Clinical and angiographic outcomes of newer-generation stents have not been described among complex patients. Methods Patients enrolled in the RESOLUTE All Comers trial (A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention) were stratified into "complex" and "simple." Results Of 2,292 patients, 1,520 (66.3%) were complex and treated with ZES (n = 764) or EES (n = 756). Event rates were higher among complex patients, and results did not differ between ZES and EES, regardless of complexity. At 1 year, target lesion failure was 8.9% in ZES- and 9.7% in EES-treated complex patients (p = 0.66) and 6.8% in ZES- and 5.7% in EES-treated simple patients (p = 0.55). Rates of cardiac death (1.3% vs. 2.2%, p = 0.24), target-vessel myocardial infarction (4.3% vs. 4.4%, p = 0.90), and clinically indicated target lesion revascularization (4.4% vs. 4.0%, p = 0.80) were similar for both stent types among complex patients. Definite or probable stent thrombosis occurred in 20 (1.3%) complex patients with no difference between ZES (1.7%) and EES (0.9%, p = 0.26). Angiographic follow-up showed similar results for ZES and EES in terms of in-stent percentage diameter stenosis (22.2 +/- 15.4% vs. 21.4 +/- 15.8%, p = 0.67) and in-segment binary restenosis (6.6% vs. 8.0%, p = 0.82) in the complex group. Conclusions In this all-comers randomized trial, major adverse cardiovascular events were more frequent among complex than simple patients. The newer-generation ZES and EES proved to be safe and effective, regardless of complexity, with similar clinical and angiographic outcomes for both stent types through 1 year. (RESOLUTE-III All Comers Trial: A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention; NCT00617084) (J Am Coll Cardiol 2011; 57: 2221-32) (C) 2011 by the American College of Cardiology Foundation
Original languageUndefined/Unknown
Pages (from-to)2221-2232
Number of pages12
JournalJournal of the American College of Cardiology
Volume57
Issue number22
DOIs
Publication statusPublished - 2011

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