The Impact of First-Versus Second-generation Drug-eluting Stent on 1-year Outcomes in Patients with ST-segment Elevation Myocardial Infarction Undergoing Primary Coronary Intervention

초록

Background: The aim of the study was to compare the efficacy and safety of secondgeneration drug-eluting stent (DES) with first-generation DES in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods: A total of 1022 patients with STEMI undergoing primary PCI were enrolled from the Korean Multicenter Endeavor (KOMER) trial (Cypher, n¼201; Taxus, n¼204; Endeavor-Sprint, n¼204), the Gil PCI registry (XienceV, n¼85; Endeavor-Resolute, n¼76), and the Korean Nobori registry (Nobori, n¼252). We excluded the patients who had been cardiogenic shock at admission, received thrombolytic therapy or had no follow-up data at 1 year. Major adverse cardiac event (MACE), defined as the composite of cardiac death, recurrent myocardial infarction (MI), or target lesion revascularization at 1 year, were compared in patients treated with the first-generation DES (Cypher, Taxus and EndeavorSprint; n¼609) versus second-generation DES (Xience V, Endeavor-Resolute and Nobori; n¼413). Results: Baseline characteristics were similar between patients treated with the firstand the second-generation DES except history of MI which was more prevalent in the second-generation DES group than in the first-generation DES group (6.1% vs. 2.0%, p¼0.001). The cumulative incidence of MACE rate was 6.4% for the first-generation DES group and 1.2% for the second-generation DES group at 1-year follow-up (p<0.001, Figure). One-year recurrent MI and TLR rate were significantly lower in the second-generation DES group than those in the first-generation DES (0.2% vs. 2.0%, p¼0.016; 0.2% vs. 2.8%, p¼0.002, respectively). However, cardiac death rate was not significantly different in the both group (0.7% vs. 1.6%, p-0.261). There was a trend towards a lower rate of stent thrombosis (definite or probable) in patients treated with the second-generation DES compared to the first-generation DES (1.6% vs. 0.2%, p¼0.058). Conclusion: As compared with the first-generation DES, the use of the second-generation DES in patients with STEMI undergoing PCI showed lower rates of MACE, recurrent MI and TLR at 1 year. There was a trend towards a lower rate of stent thrombosis with the second-generation DES compared to the first-generation DES.