Key result
First-generation drug-eluting stents had a higher risk of patient-oriented composite outcomes than second-generation stents (HR 1.467; 95% CI 1.068-2.015; p=0.018).
Why the study?
Patients with prediabetes have an increased incidence of coronary artery disease, but the relative superiority of 1G-DES versus 2G-DES after successful PCI in these patients is not well established.
Does second-generation DES improve patient-oriented composite outcomes compared to first-generation DES in patients with acute myocardial infarction and prediabetes?
Cohort (n=4,997)
Does second-generation DES improve patient-oriented composite outcomes compared to first-generation DES in patients with acute myocardial infarction and prediabetes?
Hazard Ratio: 1.467 (95% CI 1.068–2.015)
p-value: p=0.018
In patients with AMI and prediabetes, second-generation DES are associated with lower rates of composite adverse clinical outcomes and stent thrombosis at 2 years compared to first-generation DES.
May inform stent selection in prediabetic AMI patients post-PCI; leaves open the need for randomized 1G- versus 2G-DES comparisons.
Objective. To compare major clinical outcomes after successful percutaneous coronary intervention (PCI) with first-generation (1G) drug-eluting stents (DES) and second-generation (2G) DES in patients with acute myocardial infarction (AMI) and prediabetes. Background. Patients with prediabetes are associated with an increased incidence of coronary artery disease. The relative superiority of 1G- and 2G-DES in these patients is not well established. Methods. A total of 4997 patients with AMI and prediabetes were divided into two groups: the 1D-DES group (n = 726) and the 2G-DES group (n = 4271). The primary outcomes were the patient-oriented composite outcomes (POCOs) defined as all-cause death, recurrent myocardial infarction (Re-MI), and any disease revascularization at 2-year follow-up. The secondary outcome was probable or definite stent thrombosis (ST). Results. After propensity score-matching (PSM) analysis, two PSM groups (698 pairs, n = 1396, C-statistics = 0.725) were generated. The cumulative incidence rates of POCOs (hazard ratio (HR): 1.467; 95% confidence interval (CI): 1.068–2.015; p=0.018 ), any disease revascularization (HR: 2.259; 95% CI: 1.397–3.654; p=0.001 ), and ST (HR: 4.361; 95% CI: 1.243–15.30; p=0.021 ) in the 1G-DES group were significantly higher than those in the 2G-DES group. However, the cumulative incidence rates of all-cause death, cardiac death, and Re-MI were similar between the two groups. Conclusions. In patients with AMI and prediabetes, 2G-DES implantation was more efficacious than 1G-DES implantation over a 2-year follow-up period. However, further studies are needed to confirm these results.
No takes yet. Share an insight, caveat, or question.
Kim et al. (2020) conducted a cohort in Acute myocardial infarction and prediabetes (n=4,997). First-generation (1G) drug-eluting stents (DES) vs. Second-generation (2G) drug-eluting stents (DES) was evaluated on Patient-oriented composite outcomes (POCOs) defined as all-cause death, recurrent myocardial infarction (Re-MI), and any disease revascularization (HR 1.467, 95% CI 1.068-2.015, p=0.018). First-generation drug-eluting stents had a higher risk of patient-oriented composite outcomes than second-generation stents (HR 1.467; 95% CI 1.068-2.015; p=0.018).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: