Comparison of Zotarolimus-Eluting Stents With Sirolimus-Eluting and Paclitaxel-Eluting Stents Intimal Hyperplasia and Vascular Changes Assessed by Volumetric

Background—As a substudy of the large, randomized ZEST (Comparison of the Efficacy and Safety of Zotarolimus-Eluting Stent with Sirolimus-Eluting and PacliTaxel-Eluting Stent for Coronary Lesions) trial comparing first- and second-generation drug-eluting stents, we evaluated intimal hyperplasia (IH) and vascular changes using volumetric intravascular ultrasound analysis. Methods and Results—Complete angiographic and volumetric intravascular ultrasound data immediately after stenting and at 9-month follow-up were available in 162 patients with 183 lesions: 61 sirolimus-eluting stents (SES), 64 paclitaxel-eluting stents (PES), and 58 zotarolimus-eluting stents (ZES). External elastic membrane, stent, lumen, and peristent plaque volumes (external elastic membrane minus stent) were normalized by stent length. Percent IH volumes were calculated as [IH volume/stent volume]100, %. Reduction of minimal luminal area) was greater in PES than SES (1.41.5 mm2 versus 0.70.9 mm2, P0.003), whereas minimal luminal area change in ZES was not significantly different from SES (1.21.0 mm2 versus 0.70.9 mm2, P0.055). Percent IH volume was less in SES compared with PES (9.86.0 % versus 17.511.2%, P0.002) or with ZES (9.86.0 % versus 18.27.6%, P0.005). Comparing ZES versus PES, there were no significant differences in %IH volume (17.511.2 % versus 18.27.6%, P0.779) or changes in normalized lumen volume (1.21.3 mm2 versus 1.10.8 mm2, P0.452). Late stent malapposition was identified in 8 (13%) SES and 2 (3%) PES but in no ZES (P0.050). Angiographic restenosis was detected in 6 lesion