Two-Year Clinical Outcomes of Contemporary Drug-Eluting Stents Grouped by Eluted Limus Agent: A Retrospective Cohort...

Background/Objectives: Contemporary drug-eluting stents (DES) differ in antiproliferative drug, strut geometry, polymer, alloy, and drug release kinetics, and the independent association between the eluted drug and clinical outcomes remains uncertain. We compared outcomes among contemporary sirolimus-, zotarolimus-, and everolimus-eluting stents. Methods: This single-center retrospective cohort included 1940 patients who underwent percutaneous coronary intervention (PCI) between 2012 and 2021 with sirolimus- (n = 537), zotarolimus- (n = 400), or everolimus-eluting stents (n = 1003). The primary endpoint was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction (MI), or target vessel revascularization (TVR). The secondary endpoint was major adverse cardiovascular events (MACE), a composite of all-cause death, MI, or any revascularization. Stabilized inverse probability of treatment weighting (IPTW) based on pretreatment covariates and PCI era was used to address baseline and temporal differences; follow-up was censored at two years. Results: During a median follow-up of 731 days, weighted TVF rates were 5.4%, 7.7%, and 6.5% in the sirolimus, zotarolimus, and everolimus groups, respectively. Compared with sirolimus, TVF did not differ with zotarolimus (hazard ratio [HR] 1.38; 95% confidence interval [CI] 0.74-2.58) or everolimus (HR 1.19; 95% CI 0.70-2.02; overall p = 0.458). MACE also did not differ (overall p = 0.517). In complex PCI, TVF was higher with zotarolimus and everolimus than with sirolimus; however, event counts were small and the analyses were exploratory. Conclusions: In this observational cohort, no significant differences in mid-term outcomes were observed among the three drug-defined groups. Because drug type is closely intertwined with stent platform design, these findings should not be extrapolated to individual stent platforms. The exploratory complex-PCI subgroup finding requires confirmation in larger studies.