Lisette Okkels Jensen

3-Year clinical outcomes in the randomized SORT OUT III superiority trial comparing zotarolimus- and sirolimus-eluting coronary stents.

OBJECTIVES This study sought to examine the 3-year clinical outcomes in patients treated with the Endeavor (Medtronic, Santa Rosa, California) zotarolimus-eluting stent (ZES) or the Cypher (Cordis, Johnson & Johnson, Warren, New Jersey) sirolimus-eluting stent (SES) in routine clinical practice. BACKGROUND The long-term clinical outcome in patients treated with ZES in comparison with SES is unclear. METHODS The authors randomized 2,332 patients to ZES (n = 1,162) or SES (n = 1,170) implantation. Endpoints included major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction, or target vessel revascularization; the individual endpoints of MACE; and definite stent thrombosis. RESULTS At 3-year follow-up, the MACE rate was higher in patients treated with ZES than in patients treated with SES (148 [12.9%] vs. 116 [10.1%]; hazard ratio [HR]: 1.33, 95% confidence interval [CI]: 1.04 to 1.69; p = 0.022). Target vessel revascularization was more frequent in the ZES group compared with the SES group (103 [9.1%] vs. 76 [6.7%]; HR: 1.40, 95% CI: 1.04 to 1.89; p = 0.025), whereas the occurrence of myocardial infarction (3.8% vs. 3.3%) and cardiac death (2.8% vs. 2.8%) did not differ significantly. Although the rate of definite stent thrombosis was similar at 3-year follow-up (1.1% vs. 1.4%), very late (12 to 36 months) definite stent thrombosis occurred in 0 (0%) patients in the ZES group versus 12 (1.1%) patients in the SES group (p = 0.0005). CONCLUSIONS Although the 3-year MACE rate is higher in patients treated with ZES versus SES, our data highlight a late safety problem concerning definite stent thrombosis with the use of SES. This finding underscores the importance of long-term follow-up in head-to-head comparisons of drug-eluting stents. (Randomized Clinical Comparison of the Endeavor and the Cypher Coronary Stents in Non-selected Angina Pectoris Patients [SORT OUT III]; NCT00660478).

False Negative Echocardiography in an Adolescent with Anomalous Left Main Coronary Artery Origin Presenting with Cardia Arrest

A 13-year-old boy with attention deficit hyperactivity disorder treated with atomoxetin experienced cardiac collapse after physical exercise with exposure to cold water. After resuscitation using a mechanical chest compression device and treatment with extracorporeal heart lung assist, coronary angiography showed abnormal origin of the left main coronary artery and severe stenosis, which was stented. In early childhood, transthoracic echocardiography was interpreted as showing normal origins and courses of coronary arteries. The patient died, and autopsy confirmed the abnormal origin of the left main coronary artery coursing between the pulmonary artery and aorta. This case demonstrates that two-dimensional transthoracic echocardiography can lead to false negative diagnosis when assessing the origin of the left coronary artery. Thus, echocardiography may be inferior to computed tomography or magnetic resonance imaging in assessing coronary artery abnormalities. Copyright