Five-year outcomes of sirolimus-eluting versus paclitaxel-eluting stents: a propensity matched study: clinical evidence of late catch-up?

Background: Siroliums-eluting stents (SES) and paclitaxel-eluting stents (PES) have been widely used for the treatment of coronary artery disease. We investigated 5-year clinical outcomes of patients treated with SES versus PES in a multicenter registry.

Methods: We used a propensity score matching method with 2:1 matching, including 512 patients treated with SES and 256 patients treated with PES from March 2003 to December 2004. The primary endpoint was major adverse cardiac events, which included all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR).

Results: After matching, baseline characteristics were similar between the two groups. At 5 years, cumulative survival free of major adverse cardiac events, MI, and stent thrombosis did not differ between the two groups. Survival free of TVR at 5 years was higher in the SES group (88.4%) than the PES group (84.3%, Log-rank p=0.016). In contrast to the trend toward more likely target lesion revascularization in the PES group during the first 2 years (hazard ratio 0.62, p=0.057), target lesion revascularization tended to occur more frequently in the SES group from 2 to 5 years (hazard ratio 2.26, p=0.099).

Conclusions: Long-term risk of TVR was slightly lower with SES, compared with PES, despite no significant difference in major adverse cardiac events. However, the SES group had more frequent target lesion reintervention 2 to 5 years after stent implantation, whereas reintervention in the PES group occurred mainly within the first 2 years. This may reflect the temporal difference in neointimal growth of the two stent types.