Long-term PCI Outcomes in Chronic Versus Acute Coronary Syndromes (TARGET All Comers Trial).

In the TARGET All Comers trial, the biodegradable-polymer sirolimus-eluting FIREHAWK stent (BP SES) was non-inferior to the durable-polymer everolimus-eluting XIENCE stent (DP EES) with respect to target lesion failure (TLF) at 1 and 5 years; however, long-term safety and efficacy in the setting of acute coronary syndromes (ACS) are not known. We sought to assess the long-term outcomes in ACS vs chronic coronary syndromes (CCS) with BP SES vs DP EES. The TARGET AC study was a multicenter, open-label, noninferiority trial of all comer patients randomized 1:1 to BP SES or DP EES (stratified by ST-elevation myocardial infarction and study site). In this predefined substudy, outcomes were compared based on clinical presentation (ACS vs CCS) and treatment allocation. 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 between the 2 stent types; however, comorbidities were more prevalent in the CCS compared to the ACS population. TLF (15.5% vs 17.7%; p=0.24), patient-oriented outcomes (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. Among the ACS cohort, outcomes at 5 years for BP SES vs DP EES were similar for TLF (16.0% vs 14.9%; p=0.70), ischemia-driven target lesion revascularization (ID-TLR) (5.6% vs 8.3%; p=0.17), and 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 BP SES vs DP EES 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). In conclusion, in the TARGET AC trial, 1 in 3 patients had a major adverse event at 5 years irrespective of CCS or ACS presentation. Long-term, the BP sirolimus-eluting FIREHAWK stent was as safe and effective as the DP everolimus-eluting XIENCE stent across the spectrum of clinical presentations.