Jeong-Sook Seo; Duk-Woo Park; Haegeun Song; Jong Seon Park; Sun-Yang Min; Jong-Young Lee; Won-Jang Kim; Soo-Jin Kang; Seung-Whan Lee; Young-Hak Kim; Cheol Whan Lee; Jae-Joong Kim; Seong-Wook Park; Seung-Jung Park， ZEST Trial Investigators
Asan Med Cntr， Seoul， Republic of Korea
BACKGROUND Outcomes remain relatively unfavorable for stent-based coronary intervention of lesions with long diseased segments. Studies comparing the first-generation sirolimus- and paclitaxel-eluting stents and the next-generation drug-eluting stents for long coronary lesions have been limited.
METHODS Patients receiving stent implantation for long (20 mm) coronary lesions were included in our analysis following randomization in ZEST trial comparing the second-generation zotarolimus-eluting stent with the first-generation sirolimus-and paclitaxel-eluting stent in everyday clinical practice. The primary end point was a composite of major adverse cardiac events (death， myocardial infarction [MI]， and ischemia-driven target-vessel revascularization [TVR]) at 12 months.
RESULTS Among 2645 enrolled patients， 1420 patients with 1994 long lesions received a zotarolimus (471 patients， 651 lesions)， sirolimus (492 patients， 703 lesions)， or paclitaxel (457 patients， 640 lesions)-eluting stent. Baseline clinical and angiographic characteristics were similar in the three groups. At 12 months， the zotarolimus-stent group showed similar rates of major adverse cardiac events compared with the sirolimus-stent group (12.3% vs. 9.6%， P=0.17)， and fewer rates of events compared with the paclitaxel-stent group (12.3% vs. 17.1%， P=0.04). The 12-moths rate of mortality was significantly higher in the paclitaxel-stent group (zotarolimus- vs. sirolimus- vs. paclitaxel-stent， 0.4% vs. 0.4% vs. 1.8%， respectively， P=0.05). The rate of TVR also significantly differ (zotarolimus- vs. sirolimus- vs. paclitaxel-stent， 4.9% vs. 2.0% vs. 9.4%， respectively， P<0.001). A significant lower rate of stent thrombosis was detected in the sirolimus-stent group (zotarolimus- vs. sirolimus- vs. paclitaxel-stent， 0.8% vs. 0% vs. 1.1%， respectively， P=0.05).
CONCLUSIONS In this large-scale， practical randomized trial， the use of zotarolimus-eluting stents results in similar rates of major adverse cardiac events compared with sirolimus-eluting stents， and in fewer major adverse cardiac events compared with paclitaxel-eluting stents for patients with long coronary artery disease.