Key result
In patients with multivessel disease, everolimus-eluting stents were associated with a lower 1-year rate of MACE compared to first-generation DES (HR 0.58; 95% CI 0.38-0.87; P=0.009).
Why the study?
Do second-generation everolimus-eluting stents reduce major adverse cardiac events in patients with multivessel disease compared to first-generation drug-eluting stents?
Cohort (n=1,285)
Do second-generation everolimus-eluting stents reduce major adverse cardiac events in patients with multivessel disease compared to first-generation drug-eluting stents?
In patients with multivessel disease, second-generation everolimus-eluting stents were associated with a significantly lower 1-year risk of MACE compared to first-generation drug-eluting stents.
Supports preferential use of second-generation everolimus-eluting stents in multivessel disease; extends randomized comparisons of drug-eluting stent generations.
OBJECTIVE: This study aimed to compare the safety and efficacy of everolimus-eluting stents (EES) to first-generation drug-eluting stents (DES) in multivessel disease (MVD). BACKGROUND: Second-generation EES have demonstrated superiority over first-generation DES for single-vessel disease, although the merits of EES in MVD are less established. METHODS: A cohort of 1,285 patients (3,124 lesions) with ≥ 2 diseased vessels were treated with either first-generation DES (n = 1,002) or EES (n = 283). The rates of death, myocardial infarction, target lesion revascularization, target vessel revascularization, definite stent thrombosis, and major adverse cardiac events (MACE), defined as the combined incidence of target vessel revascularization, death, and non-fatal myocardial infarction, were compared at 1 year. RESULTS: Baseline characteristics were similar except for a lower left ventricular ejection fraction and a lower incidence of stable angina pectoris in the first-generation DES group (P = 0.001 and 0.013, respectively). At 1 year, the MACE rate was lower in the EES group (9.5P% vs. 15.7%; P = 0.01). Multivariable analysis demonstrated that EES use predicted a higher chance of freedom from MACE at 1 year (hazard ratio 0.58 [0.38-0.87]; P = 0.009; 95% confidence interval). CONCLUSIONS: The use of EES in patients with MVD is safe with signals for improved effectiveness compared to first-generation DES. Randomized trials comparing new-generation DES to coronary artery bypass grafting surgery are warranted.
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Minha et al. (2013) conducted a cohort in Multivessel disease (MVD) (n=1,285). Everolimus-eluting stents (EES) vs. First-generation drug-eluting stents (DES) was evaluated on Major adverse cardiac events (MACE), defined as the combined incidence of target vessel revascularization, death, and non-fatal myocardial infarction (HR 0.58, 95% CI 0.38-0.87, p=0.009). In patients with multivessel disease, everolimus-eluting stents were associated with a lower 1-year rate of MACE compared to first-generation DES (HR 0.58; 95% CI 0.38-0.87; P=0.009).
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