Three-year outcomes related to coronary stenting; a registry-based real-life population study

Jarkko Piuhola; Lauri Holmström; Mika Niemelä; Kari Kervinen; Mikko P. Tulppo; R. Asikainen; Linda Hypén; Juhani Junttila

doi:10.1080/14017431.2019.1693057

November 21, 2019Scandinavian Cardiovascular JournalOpen Access

Three-year outcomes related to coronary stenting; a registry-based real-life population study

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Why the study?

Developments in medication and coronary interventions have improved coronary artery disease treatment, prompting evaluation of long-term outcomes based on clinical presentation and stent type in a real-life population.

Do new-generation drug-eluting stents reduce MACE compared to bare-metal stents in patients undergoing PCI?

Key Points

To assess long-term clinical outcomes across three years in real-world patients with coronary artery disease undergoing percutaneous coronary intervention based on clinical presentation and stent type.
Conducted a registry-based observational study of 789 consecutive patients (mean age 65 ± 11 years, 69% male) undergoing percutaneous coronary intervention.
Tracked clinical endpoints over a three-year follow-up for a primary composite outcome of major adverse cardiac events (MACE), including all-cause mortality, myocardial infarction, and target lesion revascularization.
New-generation drug-eluting stents showed significantly lower adjusted rates of MACE compared to bare-metal stents (HR 0.47; 95% CI 0.29–0.77), with no significant difference in all-cause mortality (HR 0.50; 95% CI 0.22–1.14).
Crude mortality was significantly higher in patients presenting with STEMI (14.4%) or NSTEMI (13.7%) compared to unstable (4.5%) or stable CAD (3.1%; p < .001), but the difference was attenuated after adjustment for NSTEMI (HR 2.01; 95% CI 0.88–4.58).
Among participants who smoked at baseline, 45% successfully quit smoking, whereas 36% reached guideline-recommended cholesterol targets during follow-up.

Structured PICO

Do new-generation drug-eluting stents reduce MACE compared to bare-metal stents in patients undergoing PCI?

P

Population

789 consecutive patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI), mean age 65 ± 11, 69% male.

I

Intervention

New-generation drug-eluting stents (DES-2)

C

Comparator

Bare-metal stents (BMS)

O

Outcome

Composite outcome (MACE) of all-cause mortality, myocardial infarction, and target lesion revascularization at 3 yearscomposite

Implication

New-generation drug-eluting stents are associated with significantly lower rates of MACE compared to bare-metal stents in a real-world PCI registry.

Abstract

Objectives. Developments in medication and coronary interventions have improved coronary artery disease (CAD) treatment. We studied long-term outcomes in an observational, real-life population of CAD patients undergoing percutaneous coronary intervention (PCI) depending on the presentation and the stent type used. Design and results. Register included 789 consecutive patients undergoing PCI. Follow up period was three years with primary composite outcome (MACE) of all cause -mortality, myocardial infarction and target lesion revascularization. Mean age was 65 ± 11 and 69% were male. New-generation drug-eluting stents (DES-2) were associated with lower adjusted rates of MACE (HR 0.47; 95% CI 0.29–0.77) but not mortality (HR 0.50; 95% CI 0.22–1.14) in comparison to bare-metal stents. Patients with STEMI (14.4%) or NSTEMI (13.7%) had higher crude mortality rates than those with unstable (4.5%) or stable CAD (3.1%; p < .001). The association diminished after adjustments in NSTEMI (HR 2.01; 95% CI 0.88–4.58). Among smokers 45% quitted and 36% achieved recommended cholesterol levels. Conclusions. The overall prognosis was good. Irrespective of comorbidities, NSTEMI was not associated with worse outcome than stable CAD. DES-2 was associated with lower rates of MACE than BMS without affecting mortality rate. Patients succeeded better in smoking cessation than reaching recommended cholesterol levels.