Clinical outcomes after treatment of multiple lesions with zotarolimus-eluting versus sirolimus-eluting coronary stents (a SORT OUT III substudy)

Among 2332 patients randomized in SORT OUT III, 695 were treated for multiple lesions with zotarolimus-eluting (n = 350) or sirolimus-eluting (n = 345) stents and followed for 18 months. Major adverse cardiac events (MACE); composite of cardiac death, myocardial infarction, or target vessel revascularization (TVR); was the primary endpoint.Zotarolimus-eluting compared to sirolimus-eluting stent treatment was associated with increased MACE rate (13.2% vs. 2.6%; hazard ratio 5.29 with 95% confidence interval: 2.59-10.8). All secondary endpoints; all cause death, cardiac death, myocardial infarction, TVR, target lesion revascularization, in-stent restenosis, and definite stent thrombosis; were observed more frequently among zotarolimus-eluting stent treated patients. For all endpoints, hazard ratios were 1.6 to 4.6 times higher than in the overall results of the SORT OUT III trial.We observed better clinical outcomes among patients treated for multiple lesions with the sirolimus-eluting stent compared to those treated with the zotarolimus-eluting stent.Percutaneous coronary intervention (PCI) with drug eluting stent (DES) implantation in single coronary artery lesions has become mainstay [1]. Gradually, PCI with DES of multiple coronary artery lesions, concomitantly, has increased, and PCI of multiple lesions in patients with multivessel disease is under evaluation as an alternative or supplement to coronary artery bypass surgery [2].In some stent trials with comparison of zotarolimus-eluting and sirolimus-eluting stents, however, stent safety and efficacy have only been evaluated in patients with single lesions [3]. In other trials and registry studies, patients with single and multiple lesions have been analyzed together [4-6]. Trials comparing the zotarolimus-eluting Endeavor？ stent and the sirolimus-eluting Cypher？ stent generally favor the sirolimus-eluting stent [7]. However, a separate analysis of data on patients treated for multiple lesions has not been report