Original title: Third-generation zotarolimus-eluting and everolimus-eluting stents in all-comer patients requiring a percutaneous coronary intervention (DUTCH PEERS): a randomized, single-blind, multicentre, non-inferiority trial. Reference: Von Birgelen C et al. The Lancet. 2014; Epub ahead of print.
In the 3rd generation zotarolimus-eluting stent, platform was modified to increase flexibility and make implant easier in complex lesions. This study was designed to investigate the safety and efficacy of 2 drug-eluting stents commonly used in clinical practice that had not yet been compared in unselected patients. Between November 2010 and May 2012 this work randomized 1811 patients with de novo lesions receiving the 3rd generation zotarolimus -eluting Resolute Integrity stent (Medtronic , Santa Rosa, CA) or everolimus eluting Promus Element stent ( Boston Scientific, Natick, MA ) .
The primary end point was target vessel failure defined as cardiac death, infarct related to vessel or revascularization justified by clinical after one year. Of the total, 370 patients (20 %) were admitted pursuing a ST segment elevation myocardial infarction (STEMI) and 447 (25 %) Non-ST segment elevation (NSTE) acute coronary syndromes (ACS). The primary end point was observed in 55 (6%) of patients receiving the zotarolimus-eluting stent versus 47 (5%) of those receiving everolimus eluting stent. With these results, the Resolute Integrity stent reached the criterion for noninferiority with an absolute risk difference of 0.88 % (p = 0.006). No significant differences were observed separately analyzing each of the points of the primary end point. Stent thrombosis, either definite or definite/probable, was similar and less than 1% for both devices.
Conclusion
Both stents showed similar safety and efficacy with an excellent clinical outcome at one year, especially considering the large number of patients enrolled with acute coronary syndrome.
Editorial comment
This new generation zotarolimus-eluting stents, first time evaluated in a randomized study, achieved better results than the previous generation had shown in the RESOLUTE All Comers with a similar population.
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