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 noninferiority trial

Kyung Woo Park, Si Hyuck Kang, Hyun Jae Kang, Bon Kwon Koo, Byoung Eun Park, Kwang Soo Cha, Jay Young Rhew, Hui Kyoung Jeon, Eun Seok Shin, Ju Hyeon Oh, Myung Ho Jeong, Sanghyun Kim, Kyung Kuk Hwang, Jung Han Yoon, Sung Yun Lee, Tae Ho Park, Keon Woong Moon, Hyuck Moon Kwon, Seung Ho Hur, Jae Kean RyuBong Ryul Lee, Yong Whi Park, In Ho Chae, Hyo Soo Kim

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Abstract

Objectives This study sought to test whether the newly developed platinum chromium (PtCr)-based everolimus-eluting stent (EES) is noninferior to the cobalt chromium (CoCr)-based zotarolimus-eluting stent (ZES) in all-comers receiving percutaneous coronary intervention (PCI). Background PtCr provides improved radial strength, conformability, and visibility compared with the CoCr alloy, but PtCr-based stents have not been tested in a wide range of patients receiving PCI. Also, recent case series have raised the issue of longitudinal stent deformation (LSD) with newer drug-eluting stents. Methods We randomly assigned 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 LSD. Results At 1 year, TLF occurred in 2.9% and 2.9% of the population in the PtCr-EES and CoCr-ZES groups, respectively (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% and 0% in the PtCr-EES and CoCr-ZES groups, respectively (p = 0.104). There was no significant difference in post-deployment stent length ratio between the 2 stents (p = 0.352). Conclusions At 1 year, PtCr-EES was noninferior to CoCr-ZES in all-comers receiving PCI. Although LSD was observed only in PtCr-EES, both the stent length ratio and the frequency of LSD were not significantly different between the 2 stent types, and PtCr-EES was not associated with adverse clinical outcomes. (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-SAfety & EffectiveneSS of Drug-ElUting Stents & Anti-platelet REgimen [HOST-ASSURE]; NCT01267734).

Original languageEnglish
Pages (from-to)2805-2816
Number of pages12
JournalJournal of the American College of Cardiology
Volume63
Issue number25 PART A
DOIs
Publication statusPublished - 2014 Jul 1

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Park, K. W., Kang, S. H., Kang, H. J., Koo, B. K., Park, B. E., Cha, K. S., Rhew, J. Y., Jeon, H. K., Shin, E. S., Oh, J. H., Jeong, M. H., Kim, S., Hwang, K. K., Yoon, J. H., Lee, S. Y., Park, T. H., Moon, K. W., Kwon, H. M., Hur, S. H., ... Kim, H. S. (2014). 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 noninferiority trial. Journal of the American College of Cardiology, 63(25 PART A), 2805-2816. https://doi.org/10.1016/j.jacc.2014.04.013