Key result
Overlapping newer generation drug-eluting stents had comparable 2-year rates of major adverse cardiac events compared to non-overlapping stents (13.3% vs 10.7%, P=0.19).
Why the study?
Does overlapping newer generation drug-eluting stents increase adverse clinical outcomes compared to non-overlapping stents in patients undergoing percutaneous coronary intervention?
Observational (n=5,130)
Yes
Does overlapping newer generation drug-eluting stents increase adverse clinical outcomes compared to non-overlapping stents in patients undergoing percutaneous coronary intervention?
Absolute Event Rate: 13.3% vs 10.7%
p-value: p=0.19
Overlapping newer generation zotarolimus-eluting stents appear safe, with comparable 2-year clinical and 13-month angiographic outcomes compared to non-overlapping stents.
Supports overlapping newer-generation DES in PCI; confirms long-term safety versus non-overlapping stents.
BACKGROUND: Overlapping first generation sirolimus- and paclitaxel-eluting stents are associated with persistent inflammation, fibrin deposition and delayed endothelialisation in preclinical models, and adverse angiographic and clinical outcomes--including death and myocardial infarction (MI)--in clinical studies. OBJECTIVES: To establish as to whether there are any safety concerns with newer generation drug-eluting stents (DES). DESIGN: Propensity score adjustment of baseline anatomical and clinical characteristics were used to compare clinical outcomes (Kaplan-Meier estimates) between patients implanted with overlapping DES (Resolute zotarolimus-eluting stent (R-ZES) or R-ZES/other DES) against no overlapping DES. Additionally, angiographic outcomes for overlapping R-ZES and everolimus-eluting stents were evaluated in the randomised RESOLUTE All-Comers Trial. SETTING: Patient level data from five controlled studies of the RESOLUTE Global Clinical Program evaluating the R-ZES were pooled. Enrollment criteria were generally unrestrictive. PATIENTS: 5130 patients. MAIN OUTCOME MEASURES: 2-year clinical outcomes and 13-month angiographic outcomes. RESULTS: 644 of 5130 patients (12.6%) in the RESOLUTE Global Clinical Program underwent overlapping DES implantation. Implantation of overlapping DES was associated with an increased frequency of MI and more complex/calcified lesion types at baseline. Adjusted in-hospital, 30-day and 2-year clinical outcomes indicated comparable cardiac death (2-year overlap vs non-overlap: 3.0% vs 2.1%, p=0.36), major adverse cardiac events (13.3% vs 10.7%, p=0.19), target-vessel MI (3.9% vs 3.4%, p=0.40), clinically driven target vessel revascularisation (7.7% vs 6.5%, p=0.32), and definite/probable stent thrombosis (1.4% vs 0.9%, p=0.28). 13-month adjusted angiographic outcomes were comparable between overlapping and non-overlapping DES. CONCLUSIONS: Overlapping newer generation DES are safe and effective, with comparable angiographic and clinical outcomes--including repeat revascularisation--to non-overlapping DES.
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Farooq et al. (2013) conducted an observational in Coronary artery disease requiring stent implantation (n=5,130). Overlapping newer generation drug-eluting stents vs. No overlapping drug-eluting stents was evaluated on Major adverse cardiac events at 2 years (p=0.19). Overlapping newer generation drug-eluting stents had comparable 2-year rates of major adverse cardiac events compared to non-overlapping stents (13.3% vs 10.7%, P=0.19).
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