One‐year outcomes of patients undergoing complex percutaneous coronary intervention with three contemporary drug‐eluting stents

Abstract

Objectives We aimed to evaluate the 1‐year outcomes of three everolimus‐eluting stents (EES) for complex percutaneous coronary intervention (PCI). Background It is controversial whether contemporary bioresorbable‐polymer drug‐eluting stents (BP‐DES) are associated with better outcomes compared with durable‐polymer DES (DP‐DES). Methods Patients undergoing PCI with cobalt‐chromium (CoCr)‐DP‐EES (Xience), platinum‐chromium (PtCr)‐DP‐EES (Promus), or PtCr‐BP‐EES (Synergy) at one high‐volume institution between 2015 and 2017 were included. The primary endpoint was 1‐year major adverse cardiac events (MACE), a composite of death, myocardial infarction, and target‐vessel revascularization. Associations were also examined in patients undergoing complex PCI. Multivariable analysis was conducted to adjust for baseline differences across groups. Results We included n = 5,446 patients (CoCr‐DP‐EES, n = 3,177; PtCr‐DP‐EES, n = 1,555; PtCr‐BP‐EES, n = 714). Patients treated with PtCr‐BP‐EES had higher comorbidity burden and procedural complexity. At 1 year, MACE rates were 8.9% for CoCr‐DP‐EES versus 8.9% for PtCr‐DP‐EES versus 8.6% for PtCr‐BP‐EES (p = .97). The incidence of definite/probable stent thrombosis (ST) was also similar (0.6 vs. 0.4 vs. 0.3%, p = .69). Complex PCI was performed in n = 2,894/5,446 (53.1%). At 1 year, MACE rates were 11.5 versus 10.7 versus 10.3%, respectively (p = .83). The incidence of definite/probable ST was also similar (0.9 vs. 0.3 vs. 0.3%, p = .22). On multivariable analysis, stent type was not an independent predictor of MACE either in the overall or in the complex PCI population. Conclusions We observed comparable 1‐year rates of MACE and definite/probable ST in patients undergoing PCI with CoCr‐DP‐EES, PtCr‐DP‐EES, and PtCr‐BP‐EES. Results were unchanged among patients undergoing complex PCI. Future multicenter randomized studies should confirm and extend our findings.

Complex primary percutaneous coronary intervention with ultrathin‐strut biodegradable versus thin‐strut durable polymer drug‐eluting stents in patients with ST‐segment elevation myocardial infarction: A subgroup analysis from the BIOSTEMI randomized trial

“…Randomized evidence on the differential clinical performances of newest‐generation DESs among patients undergoing complex versus noncomplex PCI is limited to large‐scale retrospective contemporary registries 4,5,17,18 and small‐sized post hoc subgroup 2 or pooled analyses 6 from randomized controlled trials that predominately included all‐comer PCI patients. These studies yielded conflicting results with respect to the ability of newer‐generation DESs to prevent repeat revascularization in patients with complex, compared with noncomplex, coronary lesions 2,4,5,17,18 .…”

“…Randomized evidence on the differential clinical performances of newest‐generation DESs among patients undergoing complex versus noncomplex PCI is limited to large‐scale retrospective contemporary registries 4,5,17,18 and small‐sized post hoc subgroup 2 or pooled analyses 6 from randomized controlled trials that predominately included all‐comer PCI patients. These studies yielded conflicting results with respect to the ability of newer‐generation DESs to prevent repeat revascularization in patients with complex, compared with noncomplex, coronary lesions 2,4,5,17,18 . The interpretation of these findings is however hampered by important between‐studies differences in complex PCI definitions owing to the absence of available consensus documents, 2 and the inclusion of all‐comer patients that precludes the extrapolation of the study conclusions to highest‐risk patient subsets, such as patients with STEMI who are commonly underrepresented in those trials.…”

“…Our findings are consistent with a recent patient-level pooled analysis from randomized trials investigating the same newer-generation DESs as used in our study that demonstrated a nearly two fold increase in TLF and target vessel myocardial infarction rates, and a three fold increased risk for stent thrombosis among all-comer patients undergoing complex PCI. 6 Randomized evidence on the differential clinical performances of newest-generation DESs among patients undergoing complex versus noncomplex PCI is limited to large-scale retrospective contemporary registries 4,5,17,18 and small-sized post hoc subgroup 2 or pooled analyses 6 from randomized controlled trials that predominately included all-comer PCI patients. These studies yielded conflicting results with respect to the ability of newer-generation DESs to prevent repeat revascularization in patients with complex, compared with noncomplex, coronary lesions.…”

“…Patients undergoing complex PCI in the newer‐generation DES era remain however at increased long‐term risk for myocardial infarction, stent thrombosis, and repeat revascularization compared with those treated for noncomplex coronary lesions, irrespective of baseline clinical presentation 3 . Direct comparisons between contemporary DESs among patients undergoing complex PCI are limited and systematically failed to demonstrate differences in clinical outcomes between newer‐generation DESs designs with different stent strut thickness and polymer coatings 4–6 . In addition, there is paucity of data concerning the impact of procedural complexity on the long‐term clinical performance of newest‐generation DESs among highest‐risk patients with acute coronary syndrome undergoing PCI.…”

“…3 Direct comparisons between contemporary DESs among patients undergoing complex PCI are limited and systematically failed to demonstrate differences in clinical outcomes between newer-generation DESs designs with different stent strut thickness and polymer coatings. [4][5][6] In addition, there is paucity of data concerning the impact of procedural complexity on the long-term clinical performance of newest-generation DESs among highest-risk patients with acute coronary syndrome undergoing PCI.…”