Comparison of Clinical Outcomes Between First- and Second-Generation Drug-Eluting Stents in Single-Vessel Disease Patients: Up to 10-Year Follow- up Results

초록

Background There are limited long-term clinical outcome data comparing first-generation (1G) vs second-generation (2G) drug-eluting stents (DES) in patients with single-vessel disease (SVD). We sought to compare the efficacy and safety of 1G- and 2G-DES in SVD patients who underwent percutaneous coronary intervention (PCI) during 10-year clinical follow-up periods. Methods A total of 1,784 consecutive patients with SVD who underwent PCI with 1G-DES (paclitaxel- or sirolimus-eluting stent; n = 476) or 2G-DES (zotarolimus- [Endeavor, Endeavor Resolute] or everolimus-eluting stent [Promus Element, Xience]; n = 1,308) were enrolled. After propensity score matching (PSM), 2 PSM groups (355 pairs) were generated. The study endpoints were individual and composite clinical outcomes up to 10 years. Results During the 10-year follow-up period, the 2G-DES group had significantly lower incidences of myocardial infarction (MI; HR: 0.44; 95% CI: 0.22-0.92; P = 0.028), and target lesion revascularization (TLR; HR: 0.54; 95% CI: 0.32-0.91; P = 0.021) than the 1G-DES group. However, the incidence of total death, cardiac death, non–target vessel revascularization (NTVR), stroke, major adverse cardiac events (MACE), and major adverse cardiac and cerebrovascular events (MACCE) were similar between the 2 groups (Figure 1). Conclusions In our single-center, all-comer registry, 2G-DES showed a lower incidence of MI and TLR compared with 1G-DES in SVD patients during 10-year follow-up periods, showing safer and durable effect than 1G-DES.