Document Detail

Safety and efficacy of sirolimus-eluting stent implantation in patients with acute coronary syndrome in the real world.
MedLine Citation:
PMID:  21094354     Owner:  NLM     Status:  MEDLINE    
The use of drug-eluting stents in patients with acute coronary syndrome (ACS), particularly those with acute myocardial infarction (AMI), is controversial owing to concerns about late adverse events. We evaluated the long-term safety of sirolimus-eluting stent implantation in patients with ACS. Of 10,778 patients treated exclusively with a sirolimus-eluting stent in the j-Cypher registry, the 3-year outcomes of 2,308 patients with ACS (953 patients with AMI) were compared to those of 8,470 patients without ACS. Compared to patients without ACS, the patients with ACS had a significantly greater adjusted risk of death or myocardial infarction (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.12 to 1.37, p <0.0001) and definite or probable stent thrombosis (HR 1.43, 95% CI 1.11 to 1.82, p = 0.006) within the first year after sirolimus-eluting stent implantation. However, after 1 year, patients with ACS no longer had a greater risk of death or myocardial infarction (HR 1.01, 95% CI 0.90 to 1.13, p = 0.87) and stent thrombosis (HR 1.32, 95% CI 0.92 to 1.86, p = 0.13). Of the patients with ACS, those with AMI had a greater risk of death or myocardial infarction (HR 1.33, 95% CI 1.12 to 1.6, p = 0.001) and stent thrombosis (HR 1.57, 95% CI 1.05 to 2.39, p = 0.03) than those with unstable angina pectoris within the first year. However, they had a similar risk of death or myocardial infarction (HR 1.00, 95% CI 0.78 to 1.22, p = 0.83) and stent thrombosis (HR 0.83, 95% CI 0.38 to 1.6, p = 0.59) after 1 year. The risk of late adverse events >1 year after sirolimus-eluting stent implantation was similar between those with and without ACS and between those with AMI and those with unstable angina pectoris.
Ren Kawaguchi; Takeshi Kimura; Takeshi Morimoto; Shigeru Oshima; Hiroshi Hoshizaki; Kazuya Kawai; Nobuo Shiode; Yoshikazu Hiasa; Kazuaki Mitsudo;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  106     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-01-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1550-60     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
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MeSH Terms
Acute Coronary Syndrome / diagnosis,  mortality,  surgery*
Aged, 80 and over
Cause of Death
Coronary Angiography
Diagnosis, Differential
Drug-Eluting Stents*
Follow-Up Studies
Immunosuppressive Agents / pharmacology*
Japan / epidemiology
Retrospective Studies
Sirolimus / pharmacology*
Survival Rate
Treatment Outcome
Reg. No./Substance:
0/Immunosuppressive Agents; 53123-88-9/Sirolimus

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