Key result
Second-generation DES era linked to ~29% lower 5-year CV mortality versus the BMS era.
Why the study?
The impact of increasing PCI rates across the BMS, DES1, and DES2 eras on the long-term outcomes of real-world CAD patients was unknown.
Does management in the DES eras compared to the BMS era improve 5-year outcomes in patients with coronary artery disease?
Cohort (n=3,099)
Yes
Does management in the DES eras compared to the BMS era improve 5-year outcomes in patients with coronary artery disease?
Effect estimate: HR 0.712 (95% CI 0.508-0.998)
p-value: p=0.048
Despite worsening patient characteristics over time, the transition to the DES2 era was associated with reduced cardiovascular mortality at 5 years compared to the BMS era.
DES2-era management was associated with lower CV mortality; leaves open whether stent evolution or concurrent care changes drove the difference.
BACKGROUND: The availability of bare metal stents (BMS) followed by drug-eluting stents of first- (DES1) and second-generation (DES2) progressively increased the rate of the percutaneous revascularizations [percutaneous coronary intervention (PCI)] with unknown impact on the long-term outcome of real-world patients with established coronary artery disease. We sought to investigate treatments applied in patients with coronary artery disease in BMS, DES1 and DES2 eras and their 5-year outcome. METHODS: A total of 3099 consecutive patients with at least one coronary stenosis more than 50% observed in 2002 (BMS era), 2005 (DES1 era) and 2011(DES2 era) were enrolled at 13 hospitals in Veneto region, Italy. RESULTS: Moving from BMS to DES1 and DES2 eras patients became significantly older, had more comorbidities and received more frequently statins, betablockers, renin-angiotensin modulators and antiplatelets (P < 0.0001 for all). The PCI/conservative therapy ratio increased from 1.9 to 2.2 and 2.3, the PCI/coronary artery by-pass surgery ratio from 3.6 to 4.0 and 5.1. The crude 5-year survival was 84.9, 83.4 and 81.4% (P = 0.20) and survival free of myocardial infarction, stroke or further revascularizations was 62.1, 60.2 and 60.1% (P = 0.68), with cardiovascular mortality accounting for 60.9, 55.6 and 43.4% of deaths. At multivariable analysis cardiovascular mortality was significantly lower in patients enrolled in 2011 vs. 2002 (hazard ratio = 0.712, 95% confidence interval 0.508-0.998, P = 0.048). CONCLUSION: From BMS to DES1 and DES2 eras progressive worsening of patients characteristics, improvement of medical treatment standards and increase in PCI/conservative therapy and PCI/coronary artery by-pass surgery ratios were observed. Five-year outcomes remained similar in the three cohorts, but in the DES2 era cardiovascular mortality was reduced.
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Olivari et al. (2020) conducted a cohort in Coronary artery disease (n=3,099). Treatment in the second-generation drug-eluting stent (DES2) era (2011) vs. Treatment in the bare metal stent (BMS) era (2002) was evaluated on Cardiovascular mortality (HR 0.712, 95% CI 0.508-0.998, p=0.048). Treatment in the second-generation drug-eluting stent era (2011) was associated with significantly lower 5-year cardiovascular mortality compared to the bare metal stent era (2002) (HR 0.712; P=0.048).
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