Comparison of zotarolimus- and everolimus-eluting stents in patients with ST-elevation myocardial infarction and chronic kidney disease undergoing primary percutaneous coronary intervention

Background: Chronic kidney disease (CKD) is associated with poor outcomes after percutaneous coronary intervention (PCI). The aim of the study was to compare zotarolimus- and everolimus-eluting stents used during primary PCI in patients with acute myocardial infarction (AMI) and CKD. Methods: We selected 854 consecutive ST-elevation MI patients with CKD (estimated glomerular filtration rate <60 mL/min/1.73 m(2)) undergoing primary PCI who were followed up for 12 months. They were divided into two groups based on type of stents implanted: (1) zotarolimus-eluting stent (ZES) and (2) everolimus-eluting stent (EES). The study end point was the 12-month major adverse cardiac events (MACE) which included all-cause death, non-fatal MI, target lesion revascularization (TLR), and target vessel revascularization (TVR). Results: The average number of stents used per vessel was 1.4 +/- 0.7. A total of 433 patients received ZES and 421 patients received EES. There was no significant difference in the incidence of 12-month MI, TLR, or TVR. All-cause death was found to be borderline significant between two groups (2.8% in ZES vs 0.9% in EES, p = 0.05). The incidence of 12-month MACE in ZES and EES was 5.7% and 2.6% respectively, p = 0.022. Stent thrombosis did not differ between groups (p = 0.677). Kaplan-Meier analysis did not show significant difference for 12-month MACE-free survival between groups (log-rank p = 0.158). It remained the same even after propensity adjustment for multiple confounders in Cox model (p = 0.326). Conclusions: Implantation of ZES or EES provided comparable clinical outcomes with similar risk of 12-month MACE and death in STEMI patients with CKD undergoing primary PCI. (C) 2014 Published by Elsevier Ltd on behalf of Japanese College of Cardiology.