Key result
Second-generation DES show no cardiac death benefit over first-generation DES at 2 years.
Why the study?
Limited data are available regarding the long-term clinical outcomes of second-generation versus first-generation drug-eluting stents in patients with coronary chronic total occlusion undergoing PCI.
Does second-generation DES reduce cardiac death in patients with coronary chronic total occlusion compared to first-generation DES?
Observational (n=1,006)
Yes
Does second-generation DES reduce cardiac death in patients with coronary chronic total occlusion compared to first-generation DES?
Hazard Ratio: 0.86 (95% CI 0.37–1.98)
Absolute Event Rate: 2% vs 2.5%
p-value: p=0.72
In patients undergoing percutaneous coronary intervention for chronic total occlusion, second-generation drug-eluting stents demonstrated comparable 2-year clinical outcomes to first-generation drug-eluting stents.
Similar cardiac death rates observed with second- vs first-generation stents; leaves open need for randomized long-term confirmation.
BACKGROUND: Limited data are available regarding the long-term clinical outcomes of second-generation drug-eluting stents (DES) versus first-generation DES in patients with coronary chronic total occlusion (CTO) who undergo percutaneous coronary intervention (PCI). The aim of this study was to compare the clinical outcomes of second-generation DES with those of first-generation DES for the treatment of CTO. METHODS AND RESULTS: Between March 2003 and February 2012, 1,006 consecutive patients with CTO who underwent successful PCI using either first-generation DES (n = 557) or second-generation DES (n = 449) were enrolled in a multicenter, observational registry. Propensity-score matching was also performed. The primary outcome was cardiac death over a 2-year follow-up period. No significant differences were observed between the two groups regarding the incidence of cardiac death (first-generation DES versus second-generation DES; 2.5% vs 2.0%; hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.37 to 1.98; p = 0.72) or major adverse cardiac events (MACE, 11.8% vs 11.4%; HR: 1.00; 95% CI: 0.67 to 1.50; p = 0.99). After propensity score matching, the incidences of cardiac death (HR: 0.86; 95% CI: 0.35 to 2.06; p = 0.86) and MACE (HR: 0.93; 95% CI: 0.63 to 1.37; p = 0.71) were still similar in both groups. Furthermore, no significant differences were observed between sirolimus-eluting, paclitaxel-eluting, zotarolimus-eluting, and everolimus-eluting stents regarding the incidence of cardiac death or MACE. CONCLUSION: This study shows that the efficacy of second-generation DES is comparable to that of first-generation DES for treatment of CTO over 2 years of follow-up.
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Ahn et al. (2016) conducted an observational in Coronary chronic total occlusion (n=1,006). Second-generation drug-eluting stents vs. First-generation drug-eluting stents was evaluated on Cardiac death (HR 0.86, 95% CI 0.37 to 1.98, p=0.72). Second-generation drug-eluting stents were associated with a similar incidence of cardiac death compared to first-generation drug-eluting stents (2.0% vs 2.5%; HR 0.86) over a 2-year follow-up.
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