Key result
Second-generation drug-eluting stents significantly reduced the 2-year incidence of major adverse cardiac events compared to first-generation stents in acute myocardial infarction patients who currently smoke.
Why the study?
Studies comparing the effect of current smoking on first-generation versus second-generation drug-eluting stents in acute myocardial infarction patients after successful PCI were limited.
Does second-generation drug-eluting stent (2G-DES) implantation reduce major adverse cardiac events compared to first-generation drug-eluting stent (1G-DES) in acute myocardial infarction patients with a history of current smoking?
Observational (n=11,812)
Yes
Does second-generation drug-eluting stent (2G-DES) implantation reduce major adverse cardiac events compared to first-generation drug-eluting stent (1G-DES) in acute myocardial infarction patients with a history of current smoking?
Effect estimate: HR 1.281 (95% CI 1.097-1.495)
Absolute Event Rate: 7.4% vs 9.4%
p-value: p=0.002
In acute myocardial infarction patients who currently smoke, second-generation drug-eluting stents significantly reduced 2-year major adverse cardiac events compared to first-generation stents, primarily driven by lower revascularization rates.
May favor 2G-DES in smoking AMI patients; leaves open need for randomized confirmation.
There are limited studies comparing the effect of current smoking on first-generation (1G)-drug-eluting stents (DES) and second-generation (2G)-DES in acute myocardial infarction (AMI) patients after successful percutaneous coronary intervention (PCI). We investigated the clinical impact of current smoking on 2-year clinical outcomes between the 1G-DES and the 2G-DES in AMI patients after PCI.A total of 11,812 AMI patients with a history of current smoking who underwent successful PCI with 1G-DES (n = 4622) or 2G-DES (n = 7190) were enrolled. The primary endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, recurrent AMI (re-MI) or any revascularization (target lesion revascularization [TLR], target vessel revascularization [TVR], and non-TVR). The secondary endpoint was the incidence of definite or probable stent thrombosis (ST).Two propensity score-matched (PSM) groups (3900 pairs, n = 7800, C-statistic = .708) were generated. After PSM analysis, the 2-year cumulative incidence of MACE was significantly higher in the 1G-DES group compared with the 2G-DES (9.4% vs 7.4%, Log-rank P = .002; hazard ratio, 1.281; 95% confidence interval, 1.097-1.495; P = .002) and this increased incidence of MACE was associated with the increased incidence of any revascularization including TLR, TVR, and non-TVR. However, the incidences of ST, all-cause death, re-MI were not significantly different during 2-year follow-up period.2G-DES was the preferred treatment strategy for AMI patients with a history of current smoking to reduce MACE especially, any revascularization rate rather than 1G-DES in this study.
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Kim et al. (2019) conducted an observational in Acute myocardial infarction (n=11,812). Second-generation drug-eluting stents (2G-DES) vs. First-generation drug-eluting stents (1G-DES) was evaluated on Major adverse cardiac events (MACE) (HR 1.281, 95% CI 1.097-1.495, p=0.002). Second-generation drug-eluting stents significantly reduced the 2-year incidence of major adverse cardiac events compared to first-generation stents in acute myocardial infarction patients who currently smoke.
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