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Introduction <p>Drug-eluting stents are the cornerstone of treatment in patients with Acute Coronary Syndrome (ACS) undergoing Percutaneous Coronary Intervention (PCI). However, long-term comparative data on rapamycin-eluting and everolimus-eluting stents remain limited.</p> Aim <p>This study aimed to evaluate the long-term (5–7&#xa0;years) safety, effectiveness, and cost profiles of rapamycin-eluting stents versus everolimus-eluting stents in patients with ACS following PCI.</p> Method <p>This was a prospective, single-center cohort study. Consecutive patients with ACS who underwent PCI with either rapamycin-eluting stents or everolimus-eluting stents between October 2018 and October 2019 were enrolled and followed-up from November 2024 to February 2025 via clinic visits or telephone interviews. The primary outcome was the incidence of overall adverse events (AEs). The secondary outcomes included all-cause mortality, readmission rate, EuroQol Visual Analog Scale (EQ-VAS) scores, treatment costs, out-of-pocket expenses, new-onset hypertension, diabetes, and hyperlipidemia. Potential predictors of AEs were first identified by univariate logistic regression (<i>P</i> &lt; 0.1). Confounders, determined using Directed Acyclic Graphs (DAGs), were then adjusted for in a multivariable logistic regression model to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).</p> Results <p>In total, 120 patients (60 per group) were included. No significant association was found between stent type and overall AEs [27/60 (45.00%) vs. 25/60 (41.67%); adjusted odds ratio (OR) = 1.08, 95% CI 0.45–2.58; <i>P</i> = 0.87]. Although all-cause mortality [8/60 (13.33%) vs. 4/60 (6.67%); relative risk (RR) = 2.00, 95% CI 0.64–6.29; <i>P</i> = 0.24] and readmission rates [4/60 (6.67%) vs. 1/60 (1.67%); RR = 4.00, 95% CI: 0.45–35.27; <i>P</i> = 0.36] were higher in the rapamycin-eluting stent group, the differences were not statistically significant. EQ-VAS scores did not differ significantly between the groups (70.28 vs. 72.30; mean difference =  − 2.02, 95% CI − 6.70 to 2.66; <i>P</i> = 0.42). However, the everolimus-eluting stent group had significantly higher treatment costs (¥58,853.38 RMB vs. ¥48,609.22 RMB; <i>P</i> = 0.00).</p> Conclusion <p>Rapamycin-eluting stents demonstrated long-term safety and effectiveness comparable to everolimus-eluting stents in ACS patients post-PCI while offering a significant cost advantage. These findings suggest that rapamycin-eluting stents are potentially more cost-effective. For healthcare systems seeking to enhance value-based procurement, these results justify the preferential selection and wider adoption of rapamycin-eluting stents in clinical practice. However, confirmation through large-scale, multicenter, prospective studies is warranted.</p>

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Long-term safety, effectiveness, and cost of rapamycin- vs. everolimus-eluting stents in acute coronary syndrome: a real-world cohort study

  • 期刊论文

  • 发表日期：

    2025年12月10日

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  • Xiaoqing Lin,
  • Yifei Wang,
  • Songsong Tan,
  • Chunyan Kuang,
  • Yuezi Huang,
  • Jiaojiao Zhao,
  • Jiankun Yao,
  • Shining Cao,
  • Jiaxing Zhang

摘要

Introduction

Drug-eluting stents are the cornerstone of treatment in patients with Acute Coronary Syndrome (ACS) undergoing Percutaneous Coronary Intervention (PCI). However, long-term comparative data on rapamycin-eluting and everolimus-eluting stents remain limited.

Aim

This study aimed to evaluate the long-term (5–7 years) safety, effectiveness, and cost profiles of rapamycin-eluting stents versus everolimus-eluting stents in patients with ACS following PCI.

Method

This was a prospective, single-center cohort study. Consecutive patients with ACS who underwent PCI with either rapamycin-eluting stents or everolimus-eluting stents between October 2018 and October 2019 were enrolled and followed-up from November 2024 to February 2025 via clinic visits or telephone interviews. The primary outcome was the incidence of overall adverse events (AEs). The secondary outcomes included all-cause mortality, readmission rate, EuroQol Visual Analog Scale (EQ-VAS) scores, treatment costs, out-of-pocket expenses, new-onset hypertension, diabetes, and hyperlipidemia. Potential predictors of AEs were first identified by univariate logistic regression (P < 0.1). Confounders, determined using Directed Acyclic Graphs (DAGs), were then adjusted for in a multivariable logistic regression model to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Results

In total, 120 patients (60 per group) were included. No significant association was found between stent type and overall AEs [27/60 (45.00%) vs. 25/60 (41.67%); adjusted odds ratio (OR) = 1.08, 95% CI 0.45–2.58; P = 0.87]. Although all-cause mortality [8/60 (13.33%) vs. 4/60 (6.67%); relative risk (RR) = 2.00, 95% CI 0.64–6.29; P = 0.24] and readmission rates [4/60 (6.67%) vs. 1/60 (1.67%); RR = 4.00, 95% CI: 0.45–35.27; P = 0.36] were higher in the rapamycin-eluting stent group, the differences were not statistically significant. EQ-VAS scores did not differ significantly between the groups (70.28 vs. 72.30; mean difference =  − 2.02, 95% CI − 6.70 to 2.66; P = 0.42). However, the everolimus-eluting stent group had significantly higher treatment costs (¥58,853.38 RMB vs. ¥48,609.22 RMB; P = 0.00).

Conclusion

Rapamycin-eluting stents demonstrated long-term safety and effectiveness comparable to everolimus-eluting stents in ACS patients post-PCI while offering a significant cost advantage. These findings suggest that rapamycin-eluting stents are potentially more cost-effective. For healthcare systems seeking to enhance value-based procurement, these results justify the preferential selection and wider adoption of rapamycin-eluting stents in clinical practice. However, confirmation through large-scale, multicenter, prospective studies is warranted.