Stent-Related Adverse Events as Related to Dual Antiplatelet Therapy in First- vs Second-Generation Drug-Eluting Stents.
JACC Asia
; 1(3): 345-356, 2021 Dec.
Article
en En
| MEDLINE
| ID: mdl-36341224
ABSTRACT
Background:
There are limited data on the long-term stent-related adverse events as related to the duration of dual antiplatelet therapy (DAPT) in second-generation (G2) drug-eluting stents (DES) compared with first-generation (G1) DES.Objectives:
This study sought to compare the long-term stent-related outcomes of G2-DES with those of G1-DES.Methods:
The study group consisted of 15,009 patients who underwent their first coronary revascularization with DES from the CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Grafting) Registry Cohort-2 (first-generation drug-eluting stent [G1-DES] period; n = 5,382) and Cohort-3 (second-generation drug eluting stent [G2-DES] period; n = 9,627). The primary outcome measures were definite stent thrombosis (ST) and target vessel revascularization (TVR).Results:
The cumulative 5-year incidences of definite ST and TVR were significantly lower in the G2-DES group than in the G1-DES group (0.7% vs 1.4%; P < 0.001; and 16.2% vs 22.1%; P < 0.001, respectively). The lower adjusted risk of G2-DES relative to G1-DES for definite ST and TVR remained significant (HR 0.53; 95% CI 0.37-0.76; P < 0.001; and HR 0.74; 95% CI 0.68-0.81; P < 0.001, respectively). In the landmark analysis that was based on the DAPT status at 1 year, the lower adjusted risk of on-DAPT status relative to off-DAPT was significant for definite ST beyond 1 year in the G1-DES stratum (HR 0.42; 95% CI 0.24-0.76; P = 0.004) but not in the G2-DES stratum (HR 0.66; 95% CI 0.26-1.68; P = 0.38) (P interaction = 0.14).Conclusions:
G2-DES compared with G1-DES were associated with a significantly lower risk for stent-related adverse events, including definite ST and TVR. DAPT beyond 1 year was associated with a significantly lower risk for very late ST of G1-DES but not for that of G2-DES.
ACS, acute coronary syndrome; ARC, Academic Research Consortium; ARC-HBR, Academic Research Consortium High Bleeding Risk; BMS, bare-metal stent; CABG, coronary artery bypass grafting; DAPT, dual antiplatelet therapy; DES, drug-eluting stent(s); EES, everolimus-eluting stent(s); G1, first-generation; G2, second-generation; PCI, percutaneous coronary intervention; PES, paclitaxel-eluting stent(s); SES, sirolimus-eluting stent(s); ST, stent thrombosis; TVR, target vessel revascularization; ZES, zotarolimus-eluting stent(s); drug-eluting stent; dual antiplatelet therapy; stent thrombosis
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Colección:
01-internacional
Banco de datos:
MEDLINE
Idioma:
En
Revista:
JACC Asia
Año:
2021
Tipo del documento:
Article
País de afiliación:
Japón