Long-term PCI outcomes in chronic versus acute coronary syndromes: 5-year results of the TARGET All Comers trial

Abstract Introduction In the TARGET AC trial, the biodegradable-polymer sirolimus-eluting Firehawk stent was non-inferior to the everolimus-eluting XIENCE stent with respect to target lesion failure (TLF) at 12 months; however, long-term safety and efficacy in the setting of an acute coronary syndrome (ACS) are not known. Purpose To assess the long-term outcomes in ACS vs chronic coronary syndromes (CCS) with the Firehawk stent vs the XIENCE stent Methods The TARGET AC study was a multicentre, open label, noninferiority trial of all comer patients randomised 1:1 (stratified by STEMI) to Firehawk or XIENCE stents. In this substudy, outcomes were compared based on clinical presentation (ACS vs CCS) and treatment allocation. Results A total of 1653 patients were enrolled (728 with ACS and 922 with CCS) with 94% completing 5-year follow-up. Baseline characteristics were well matched. Target lesion failure (TLF) (15.5% vs 17.7%; p=0.24), patient-oriented composite endpoint (death, any myocardial infarction, or any revascularization) (32.0% vs 34.4%; p=0.31), and stent thrombosis (4.1% vs 3.3%; p=0.40) were similar between ACS and CCS patients (Table 1). Among the ACS cohort, outcomes at 5 years for Firehawk vs XIENCE were not different for TLF (16.0% vs 14.9%; p=0.70), ischemia-driven target lesion revascularisation (ID-TLR) (5.6% vs 8.3%; p=0.17), or definite/probable stent thrombosis (2.7% vs 4.6%; p=0.18). The same was true for the CCS cohort, with 5-year outcomes for Firehawk vs XIENCE for TLF (18.0% vs 17.4%; p=0.82), ID-TLR (6.4% vs 5.0%; p=0.37), and definite/probable stent thrombosis (3.0% vs 1.8%; p=0.26) similar between groups. Conclusions One in three patients presenting with CCS or ACS had a major adverse event at 5 years. Long-term, the Firehawk stent was as safe and effective as the XIENCE stent irrespective of clinical presentation.