Long‐term outcome in patients treated with first‐ versus second‐generation drug‐eluting stents for the treatment of unprotected left main coronary artery stenosis

Abstract

Objective and background The study aim is to provide long‐term clinical outcome after percutaneous coronary intervention (PCI) for unprotected left main coronary arteries (ULMCA) stenosis with the first‐generation (1st‐gen) drug‐eluting stents (DES) in comparison to 2nd‐gen DES, since this is largely unknown. Methods Between May 2002, and December 2014, a consecutive series of 656 all‐comer patients underwent a PCI for ULMCA stenosis at the Erasmus Medical Center. A total of 235 patients were treated with 1st‐gen DES, while a total of 421 patients were treated with 2nd‐gen DES. Results Overall, the population consisted of 73% males and 58% presented with an acute coronary syndrome. Median follow‐up time was 1,361 days (range from 0 to 5,031). At 5 years, the cumulative incidence of major adverse clinical events (the primary composite endpoint of all‐cause death, any myocardial infarction or target lesion revascularization; MACE) did not differ between 1st‐ and 2nd‐gen DES (36.8 vs. 38.6%, respectively, Log Rank p = .79, adjusted hazard ratio [HR] = 1.28 [95% confidence interval (CI) 0.94–1.74]). No difference was found in the individual endpoints of all‐cause mortality (29.5 vs. 29% respectively, p = .88, adjusted HR = 1.19 [95% CI, 0.84–1.68]), target vessel myocardial infarction (5.0 vs. 8.4%, p = 0.17, adjusted HR = 1.75 [95% CI, 0.78–3.96]) and target lesion revascularization (8.1 vs. 9.8%, p = .94, adjusted HR = 1.16 [95% CI, 0.59–2.29]) between the 1st‐ and 2nd‐gen DES cohorts, respectively. Conclusions In this large cohort of consecutive patients treated for ULMCA stenosis, no significant differences were found in the safety and efficacy of 1st versus 2nd‐gen DES at 5 years follow‐up.

Trends in Clinical Practice and Outcomes After Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery

“…Available studies report a 5‐year MACE rate of 34.4% (n=383, age 72.3±9.7 years) 20 and 38.6% (n=421, age 68.4±11.5 years). 21 A large study (n=11 264) reported a 1‐year death rate of 11.5%. 9 Lee et al observed a 3‐year MACCE rate of 16.0% in 1658 individuals treated with new‐generation stents.…”

The Incidence and Possible Predictors of Coronary Restenosis

“…По данным 3-[10] и 5-летнего [11] наблюдения, по сравнению со стентами I поколения применение стентов II поколения ассоциировалось с меньшей частотой повторной реваскуляризации целевых поражений. Однако по данным 5-летнего наблюдения [12], группы пациентов со стентированием ствола левой коронарной артерии и имплантированными стентами I и II поколений не различались по частоте повторной реваскуляризации целевого поражения, частоте развития тяжелых сердечно-сосудистых осложнений. По данным 5-летнего наблюдения, необходимость повторной реваскуляризации целевого поражения после имплантации стентов I поколения, содержащих сиролимус, в течение первого года наблюдения была низкой, однако при дальнейшем наблюдении частота повторной реваскуляризации целевого поражения не снижалась [13].…”

Drug-Eluting, Bioresorbable Cardiovascular Stents─Challenges and Perspectives

“…Several comparative studies of first- and second-generation stents have been carried out. − For example, the SPIRIT II clinical study compared the Taxus Express stents with the Xience V (everolimus) drug-eluting stents. After six months, the Xience V had a late loss of lumen (difference in millimeters between the diameter of a stented segment after the procedure compared to the follow-up angiogram at six or nine months) of 0.11 mm compared to 0.36 mm in the Taxus Express, thereby reducing the probability of developing restenosis and a myocardial infarction. , …”