Long-term ACS outcomes similar between TiNO-coated and everolimus-eluting stents

Neither titanium-nitride-oxide (TiNO)–coated stents nor third-generation everolimus-eluting stents (EES) are necessarily better than the other in the treatment of patients with acute coronary syndromes (ACS), with a study showing no significant difference in long-term outcomes following placement of TiNO-coated stents or EES.

The multicentre, open-label trial was conducted in 12 clinical sites across five European countries. A total of 1,491 patients (mean age 62.7 years, 24.3 percent women) with ACS (ST-segment elevation myocardial infarction [MI], non–ST-segment elevation MI, and unstable angina) and at least one de novo lesion were enrolled. These patients were randomly assigned to receive either a TiNO-coated stent (n=989) or an EES (n=502).

At 5 years, the primary endpoint of the composite of cardiac death, MI, or target lesion revascularization occurred in 111 patients in the TiNO group and in 60 patients in the EES group (11.2 percent vs 12.0 percent, respectively). The difference in the composite events was not significant (hazard ratio [HR], 0.94, 95 percent confidence interval [CI], 0.69–1.28; p=0.69).

When the events were assessed separately, the corresponding rates in the TiNO and EES groups were 0.9 percent vs 3.0 percent for cardiac death (HR, 0.30, 95 percent CI, 0.13–0.69; p=0.005), 4.6 percent vs 7.0 percent for MI (HR, 0.64, 95 percent CI, 0.41–0.99; p=0.049), 1.2 percent vs 2.8 percent for stent thrombosis (HR, 0.43, 95 percent CI, 0.20–0.93; p=0.034), and 7.4 percent vs 6.4 percent for target lesion revascularization (HR, 1.16, 95 percent CI, 0.77–1.76; p=0.47).

The present data show that while TiNO-coated stents and biodegradable polymer EES were similar in terms of the composite events, the reductions in cardiac death, MIs, and stent thromboses were greater with TiNO stents.