Comparative effectiveness of Orsiro, Xience, Synergy, and Resolute stent in patients with acute myocardial infarction undergoing percutaneous coronary intervention: a nationwide registry study

BACKGROUND: Head-to-head comparisons of contemporary drug-eluting stents (DES) in patients with acute myocardial infarction (AMI) remain limited. We sought to compare the long-term clinical outcomes of four widely used DES platforms: Orsiro, Xience, Synergy, and Resolute. METHODS: From the nationwide prospective Korea acute myocardial infarction registry-V, we identified 9284 patients with AMI undergoing percutaneous coronary intervention with one of the four study devices (Orsiro, n = 1634; Xience, n = 2576; Synergy, n = 2811; Resolute, n = 2263). The primary endpoint was target lesion revascularization (TLR). Inverse probability of treatment weighting was performed to adjust for baseline differences. RESULTS: During a median follow-up of 723 days, the cumulative incidence of TLR differed significantly among groups. In IPTW-adjusted analyses, compared with the Orsiro group (reference), the risk of TLR was significantly higher in the Synergy [hazard ratio: 2.30; 95% confidence interval (CI): 1.20-4.41, P = 0.013] and Resolute groups (hazard ratio: 2.30, 95% CI: 1.18-4.47, P = 0.014). The Xience group showed a comparable risk of TLR to Orsiro (hazard ratio: 1.40, 95% CI: 0.69-2.82, P = 0.346). Target vessel revascularization followed a similar pattern, favoring Orsiro. However, there were no significant differences in composite major adverse cardiovascular events or all-cause mortality among the four groups. CONCLUSION: In this large-scale, real-world AMI cohort, the ultrathin-strut, biodegradable-polymer Orsiro stent was associated with a lower risk of repeat revascularization compared with the Synergy and Resolute stents. Xience demonstrated comparable outcomes to Orsiro. Stent selection remains a crucial determinant of vessel-level outcomes in patients with AMI.