Comparison of Efficacy and Safety between First- and Second-Generation Drug-Eluting Stents in Patients with Acute Coronary Syndrome.
- Author:
Yuan-Liang MA
1
;
Xiao-Fang TANG
1
;
Yi YAO
1
;
Na XU
1
;
Ying SONG
1
;
Ping JIANG
1
;
Jing-Jing XU
1
;
Huan-Huan WANG
1
;
Lin JIANG
1
;
Ru LIU
1
;
Xue-Yan ZHAO
1
;
Jue CHEN
1
;
Zhan GAO
1
;
Shu-Bin QIAO
1
;
Yue-Jin YANG
1
;
Run-Lin GAO
1
;
Bo XU
1
;
Jin-Qing YUAN
1
Author Information
- Publication Type:Journal Article
- Keywords: Acute Coronary Syndrome; First-Generation Drug-Eluting Stent; Percutaneous Coronary Intervention; Second-Generation Drug-Eluting Stent; Stent Thrombosis
- MeSH: Acute Coronary Syndrome; surgery; Aged; Coronary Thrombosis; surgery; Drug-Eluting Stents; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Infarction; surgery; Percutaneous Coronary Intervention; methods; Prospective Studies
- From: Chinese Medical Journal 2018;131(12):1397-1405
- CountryChina
- Language:English
-
Abstract:
Background:It remains undetermined whether second-generation drug-eluting stents (G2-DESs) outperform first-generation DESs (G1-DESs) in patients with acute coronary syndrome (ACS). We aimed to compare the efficacy and safety of G1-DES and G2-DES in ACS patients in a high-volume cardiovascular center.
Methods:In 2013, 10,724 consecutive patients underwent percutaneous coronary intervention in our institution. We included 4037 patients with ACS who underwent exclusively G1-DES or G2-DES implantation (n = 364 and n = 3673, respectively). We used propensity score matching to minimize the imbalance between the G1-DES and G2-DES groups and followed patients for 2 years. The efficacy endpoints were major adverse cardiac events (MACEs) and its components including target vessel-related myocardial infarction (TV-MI), target vessel revascularization/target lesion revascularization (TVR/TLR), and cardiac death. The safety endpoint was stent thrombosis. Continuous variables were compared by Mann-Whitney U-test, and categorical variables were compared using Pearson's Chi-square or Fisher's exact test. Kaplan-Meier curves were constructed to compare the event-free survival rates, and multivariate Cox proportional hazards regression analysis was used to assess whether stent type was an independent risk factor for the efficacy and safety endpoints.
Results:At the 2-year follow-up, the results for MACE and it components, as well as stent thrombosis, were similar for G1-DES and G2-DES (MACE, 5.2% vs. 4.3%, χ = 0.514, P = 0.474; TV-MI, 0.8% vs. 0.4%, P = 0.407; TVR, 4.9% vs. 3.7%, χ = 0.939, P = 0.333; TLR, 3.8% vs. 2.5%, χ = 1.610, P = 0.205; cardiac death, 0.3% vs. 0.5%, P = 0.670; and stent thrombosis, 0.5% vs. 0.4%, P > 0.999). Kaplan-Meier analysis indicated similar event-free survival rates between G1-DES and G2-DES after propensity score matching (all: log-rank P > 0.05). Multivariate analysis demonstrated that stent type was not an independent risk factor for the efficacy and safety endpoints (MACE, hazard ratio [HR] = 0.805, 95% confidence interval [CI]: 0.455-1.424, P = 0.456; TV-MI, HR = 0.500, 95% CI: 0.101-2.475, P = 0.395; TVR, HR = 0.732, 95% CI: 0.403-1.330, P = 0.306; TLR, HR = 0.629, 95% CI: 0.313-1.264, P = 0.193; cardiac death, HR = 1.991, 95% CI: 0.223-17.814, P = 0.538; and stent thrombosis, HR = 0.746, 95% CI: 0.125-4.467, P = 0.749).
Conclusion:G1-DES and G2-DES have similar efficacy and safety profiles in ACS patients at the 2-year follow-up.
