New-generation drug-eluting stents reduce stent thrombosis and myocardial infarction: a propensity-score-adjusted analysis from the multicenter REAL registry (REgistro Regionale AngiopLastiche Dell'Emilia-Romagna)

Catheter Cardiovasc Interv. 2015 Apr;85(5):797-806. doi: 10.1002/ccd.25675. Epub 2014 Oct 14.

Abstract

Objectives: The aim of this study was to compare long-term clinical outcomes in patients treated with new-generation drug-eluting stent (DES) or early-generation DES in a real-world registry.

Background: New-generation DESs have proved to be more effective and safer than early-generation DES in randomized trials. However, the effects of new-generation DES versus early-generation DES in everyday clinical practice deserve further verification.

Methods: A propensity-score and inverse-probability weighted analysis of 5,332 patients undergoing DES implantation (2,557 new-generation and 2,775 early-generation) between January 1, 2007 and June 30, 2011 was performed, with a median follow-up of 3 years. We assessed the incidence of major adverse cardiovascular events (MACE: all-cause death, nonfatal myocardial infarction [MI], and target vessel revascularization [TVR]), and angiographic stent thrombosis (ST) during follow-up.

Results: At 3-years, new-generation DES in comparison with early-generation DES were associated with a reduced risk of MI (5% versus 7.4%, hazard ratio [HR]=0.65, 95% confidence interval [CI]=0.51-0.82, P=0.0004) and angiographic ST (0.5% vs. 1.1%, HR=0.35, 95% CI 0.17-0.72, P=0.004), whereas, the risk of TVR (10.9% vs. 13.5%; HR 0.99, 95% CI 0.84-1.16, P=0.99) and overall MACE was not significantly different (19.2% vs. 22.4%, HR=0.94, 95% CI=0.83-1.07, P=0.35).

Conclusions: Our data from a large all-comers multicenter registry confirm that, in comparison with early-generation DES, the use of new-generation DES is associated with similar efficacy and increased long-term safety, because of a reduced risk of ST and MI.

Keywords: drugs; myocardial infarction; revascularization; stents; thrombosis.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Coronary Artery Disease / surgery*
  • Coronary Thrombosis / epidemiology
  • Coronary Thrombosis / prevention & control*
  • Drug-Eluting Stents*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Italy / epidemiology
  • Male
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / prevention & control*
  • Percutaneous Coronary Intervention*
  • Propensity Score
  • Prospective Studies
  • Prosthesis Design
  • Survival Rate / trends
  • Time Factors