First- Versus Second-Generation Drug-Eluting Stents in Acute Coronary Syndromes (Katowice-Zabrze Registry)

Abstract

BackgroundThere are sparse data on the performance of different types of drug-eluting stents (DES) in acute and real-life setting.ObjectiveThe aim of the study was to compare the safety and efficacy of first- versus second-generation DES in patients with acute coronary syndromes (ACS).MethodsThis all-comer registry enrolled consecutive patients diagnosed with ACS and treated with percutaneous coronary intervention with the implantation of first- or second-generation DES in one-year follow-up. The primary efficacy endpoint was defined as major adverse cardiac and cerebrovascular event (MACCE), a composite of all-cause death, nonfatal myocardial infarction, target-vessel revascularization and stroke. The primary safety outcome was definite stent thrombosis (ST) at one year.ResultsFrom the total of 1916 patients enrolled into the registry, 1328 patients were diagnosed with ACS. Of them, 426 were treated with first- and 902 with second-generation DES. There was no significant difference in the incidence of MACCE between two types of DES at one year. The rate of acute and subacute ST was higher in first- vs. second-generation DES (1.6% vs. 0.1%, p < 0.001, and 1.2% vs. 0.2%, p = 0.025, respectively), but there was no difference regarding late ST (0.7% vs. 0.2%, respectively, p = 0.18) and gastrointestinal bleeding (2.1% vs. 1.1%, p = 0.21). In Cox regression, first-generation DES was an independent predictor for cumulative ST (HR 3.29 [1.30-8.31], p = 0.01).Conclusions In an all-comer registry of ACS, the one-year rate of MACCE was comparable in groups treated with first- and second-generation DES. The use of first-generation DES was associated with higher rates of acute and subacute ST and was an independent predictor of cumulative ST.

Real-Life Outcomes of Coronary Bifurcation Stenting in Acute Myocardial Infarction (Zabrze–Opole Registry)

“…Nevertheless, the rates of cumulative ST were very low. Contrary to previously published data [22], the rate of cumulative ST was driven mainly by late events. It is not surprising, considering that the major concern accompanying the implantation of DES is very late ST [23,24].…”

Two-Year Outcomes for Patients with Non-ST-Elevation Acute Coronary Syndrome Treated with Magmaris and Absorb Bioresorbable Scaffolds in Large-Vessel Lesions

“…Since their introduction into clinical practice, second-generation drug-eluting stents (DESs) have become the gold standard in percutaneous coronary intervention (PCI). Despite the undeniable improvement in the clinical outcome of modern DESs compared to BMS or the first generation of DESs [22], there are still some shortcomings associated with the permanent caging of the vessel with a metal backbone [23]. To overcome these limitations and potentially reduce long-term adverse events, the concept of bioresorbable scaffolds has been developed.…”

Definite stent thrombosis after drug‐eluting stent implantation in coronary bifurcation lesions: A meta‐analysis of 3,107 patients from 14 randomized trials

“…The sirolimus‐eluting stent (SES) Cypher® and the paclitaxel‐eluting stent (PES) TAXUS® were the first two DES to gain regulatory approval, in 2003 and 2004, respectively. However, very‐late ST events and a relatively high rates of restenosis triggered the development of the second generation DES with thinner struts (Cobalt chromium), more biocompatible polymers and limus drugs, which were associated with better outcomes in PCI .…”