Comparison of Clinical Outcomes Between First-and Second-Generation Drug-Eluting Stents in Elderly Patients: 10-Year Follow-Up Results

초록

Background The second-generation (2G) drug-eluting stents (DES) have been used to Coronary Artery Disease. There are very limited long-term clinical outcome data comparing first-generation (1G) versus 2G-DES in Elderly (≥65 years of age) patients undergoing percutaneous coronary intervention (PCI). The study aimed to compare the efficacy and safety 2G-DES with 1G-DES in Elderly patients who underwent PCI during 10-year clinical follow-up periods. Methods The outcomes of 1,280 consecutive Elderly patients who underwent PCI with 1G-DES (paclitaxel-, sirolimus-eluting stent, n=561) or 2G-DES (zotarolimus [endeavor, endeavor resolute]- or everolimus-eluting stent [promus element, xience], n=719) were enrolled. The study endpoints were individual and composite clinical outcomes up to ten-year. After PSM, two propensity-matched (PSM) groups (345pairs) were generated. Results During the 10-year follow-up period, the 2G-DES group had a lower incidence of any revascularization (hazard ratio [HR], 0.58; 95% confidence interval [CI], 0.40 – 0.85; p=0.005), target lesion revascularization (TLR; HR,0.36; 95% CI, 0.21 – 0.62; p<0.001), target vessel revascularization (TVR; HR,0.42; 95% CI, 0.26 – 0.67; p<0.001), total major adverse cardiac events (MACE; HR, 0.70; 95% CI, 0.53 – 0.93; p = 0.014), TLR MACE (HR, 0.61; 95% CI, 0.41 –0.91; p=0.017) and MACCE (HR, 0.70; 95% CI, 0.53 – 0.92; p = 0.011, table). However, the cumulative incidence of total death, cardiac death, MI, non-TVR and cerebrovascular disease were similar between the two groups (Table). Conclusion In our single-center, all-comer registry, 1G-DEShad comparable efficacy compared with 2G-DES in Elderly patients except lower incidence of TLR, TVR, MACE and TLR MACE in 2G-DES during 10-year follow-up periods.