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

초록

Background There are very limited long-term clinical outcome data comparing first-generation (1G) versus second-generation (2G) drug-eluting stents (DES) in multi-vessel disease (MVD) patients. The authors sought to compare the efficacy of 1G- and 2G-DES in MVD patients who underwent percutaneous coronary intervention (PCI) during 10-year clinical follow-up periods. Methods A total of 680 consecutive patients with MVD who underwent PCI with 1G-DES (paclitaxel-[Taxus], sirolimus-eluting stent[Cypher], n=299) or 2G-DES (zotarolimus [Endeavor, Endeavor Resolute]- or everolimus-eluting stent [Promus Element, Xience], n=381) were enrolled. After propensity score matching (PSM), two PSM groups (172 pairs) were generated. The study endpoints were individual and composite clinical outcomes up to 10-year. Results During the 10-year follow-up period, the 2G-DES group had significantly lower incidences of total death (hazard ratio [HR]; 0.48, 95% confidence interval [CI]; 0.24-0.97, p= 0.040), myocardial infarction (MI, HR; 0.39, 95% CI; 0.16-0.96, p=0.040), revascularization (HR; 0.49, 95% CI; 0.31-.077, p=0.002), target lesion revascularization (TLR, HR; 0.37, 95 CI%: 0.21-0.67, p<0.001), target vessel revascularization (TVR; HR: 0.55, 95% CI: 0.34-0.89, p=0.014), major adverse cardiac event (MACE; HR; 0.53, 95% CI; 0.36-0.78, p<0.001), TLR-MACE (HR; 0.48, 95% CI; 0.29-0.78, p=0.004), and major adverse cardiac and cerebrovascular events (MACCE, HR; 0.55, 95 CI; 0.38-0.79, p<0.001) than 1G-DES group (table). Conclusion In our single-center, all-comer registry, the 2G-DES group showed better efficacy and safety compared to 1G-DES including less incidence of total death, MI, revascularization, TLR, TVR, MACE, TLR MACE, MACCE during 10-year follow-up periods.