A propensity score matched analysis to determine if second-generation drug-eluting stents outperform first-generation drug-eluting stents in a complex patient population.
Citation: International Journal of Cardiology. 170(1):43-8, 2013 Dec 5.PMID: 24169532Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal ArticleSubject headings: *Drug-Eluting Stents/st [Standards] | *Myocardial Infarction/su [Surgery] | *Population Surveillance/mt [Methods] | *Propensity Score | *Thrombosis/pc [Prevention & Control] | Aged | Female | Follow-Up Studies | Humans | Male | Middle Aged | Myocardial Infarction/di [Diagnosis] | Myocardial Infarction/ep [Epidemiology] | Percutaneous Coronary Intervention/st [Standards] | Prospective Studies | Thrombosis/ep [Epidemiology] | Treatment OutcomeISSN:- 0167-5273
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Journal Article | MedStar Authors Catalog | Article | Available | 24169532 |
BACKGROUND: Drug-eluting stents (DES) are routinely used in complex patients, but the impact of 1st- versus 2nd-generation DES on clinical outcomes has not been well described. This study aimed to assess the efficacy and safety of 2nd-generation (everolimus-eluting) DES compared to 1st-generation (sirolimus- and paclitaxel-eluting) DES in a selected, higher-risk population with complex clinical and angiographic features.
CONCLUSION: In this propensity score matched patient population with complex features undergoing percutaneous coronary intervention, the use of 2nd-generation DES was associated with lower rates of stent thrombosis, and similar 1-year major adverse cardiac events compared to 1st-generation DES. 2013.
METHODS: The study included 5693 consecutive patients with the presence of > 1 predefined complex clinical and angiographic characteristic treated with either generation DES. Using propensity score matching, the clinical outcomes of 1076 patients treated with 2nd-generation DES were compared with the outcomes of a matched population treated with 1st-generation DES over 1-year follow-up.
RESULTS: After matching, baseline clinical and angiographic characteristics were similar between groups. At 1-year follow-up, the rate of major adverse cardiac events was 9.4% with 2nd-generation DES and 11.3% with 1st-generation DES (p=0.16). There were no significant differences in the rates of death (3.2 vs. 4.0%, p=0.30), myocardial infarction (1.6 vs. 1.3%, p=0.57), target vessel revascularization (5.9 vs. 7.3%, p=0.17) or target lesion revascularization (4.4 vs. 5.0%, p=0.50). Definite stent thrombosis was less frequent with 2nd-generation DES (0.1 vs. 0.8%, p=0.011), as was definite or probable stent thrombosis (0.7 vs. 1.6%, p=0.040).
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