A Randomized Comparison of Platinum Chromium-Based Everolimus-Eluting Stents Versus Cobalt Chromium-Based Zotarolimus-Eluting Stents in All-Comers Receiving Percutaneous Coronary Intervention: HOST–ASSURE (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis–Safety & Effectiveness of Drug-Eluting Stents & Anti-platelet Regimen), a Randomized, Controlled, Noninferiority Trial

Study Questions:

What is the safety and efficacy of the platinum chromium (PtCr)-based everolimus-eluting stent (EES) compared to the cobalt chromium (CoCr)-based zotarolimus-eluting stent (ZES) in all-comers receiving percutaneous coronary intervention (PCI)?

Methods:

The HOST-ASSURE study randomized 3,755 all-comers receiving PCI to PtCr-EES or CoCr-ZES. The primary outcome was target lesion failure (TLF) at 1-year post-PCI, defined as the composite of cardiac death, nonfatal target vessel-related myocardial infarction, and ischemia-driven target lesion revascularization. Post-hoc angiographic analysis was performed to qualitatively and quantitatively analyze longitudinal stent deformation (LSD).

Results:

There was no difference in TLF at 1 year (2.9% vs. 2.9%, superiority p = 0.98, noninferiority p = 0.0247). There were no significant differences in the individual components of TLF as well as the patient-oriented clinical outcome. Of 5,010 stents analyzed, LSD occurred in 0.2% of the PtCr-EES stents and none of the CoCr-ZES stents (p = 0.104). There was no significant difference in post-deployment stent length ratio between the two stents (p = 0.352).

Conclusions:

At 1 year, PtCr-EES was noninferior to CoCr-ZES in all-comers receiving PCI. LSD was uncommon and observed only in PtCr-EES, but was not associated with adverse clinical outcomes.

Perspective:

The second-generation drug-eluting stents (DES) have demonstrated remarkable safety and efficacy, and delivered better results compared with first-generation DES as well as bare-metal stents. This study provides comparative data on the PtCr-EES and the CoCr-ZES, and demonstrates remarkably similar outcomes with the two stents. This study adds to the growing data demonstrating broadly similar outcomes with the three second-generation DES.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Chronic Angina

Keywords: Myocardial Infarction, Coronary Restenosis, Cobalt, Drug-Eluting Stents, Platinum, Chromium, Sirolimus, Percutaneous Coronary Intervention


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