Comparison of Contemporary Drug-Eluting Stents in Patients Undergoing Complex High-Risk Indicated Procedures.
JACC Asia
; 2(2): 182-193, 2022 Apr.
Article
em En
| MEDLINE
| ID: mdl-36339122
ABSTRACT
Background:
Limited data are available on the relative performances of diverse contemporary drug-eluting stents (DES) in patients undergoing complex high-risk indicated procedures (CHIP).Objectives:
The purpose of this study was to evaluate the comparative effectiveness of contemporary second-generation DES for CHIP patients in "real-world" settings.Methods:
Of 28,843 patients enrolled in the IRIS-DES registry, a total of 6,645 patients with CHIP characteristics who received 5 different types of contemporary DES were finally included 3,752 with cobalt-chromium everolimus-eluting stents (CoCr-EES), 1,258 with Resolute zotarolimus-eluting stents (Re-ZES), 864 with platinum-chromium EES (PtCr-EES), 437 with ultrathin strut biodegradable-polymer sirolimus-eluting stents (UT-SES), and 334 with bioresorbable polymer SES (BP-SES). The primary outcome was target-vessel failure (a composite of cardiac death, target-vessel myocardial infarction, and target-vessel revascularization) at 12 months.Results:
At 12 months, the rate of target-vessel failure was highest in the CoCr-EES (7.1%) group; intermediate in the Re-ZES (5.0%), PtCr-EES (4.6%), and BP-SES (4.2%) groups; and lowest in the UT-SES (3.8%) group (overall long-rank P = 0.001). In multiple-treatment propensity-score analysis, the adjusted hazard ratios (HRs) for target-vessel failure were significantly lower in the Re-ZES (HR 0.71; 95% confidence interval [CI] 0.52-0.97), the UT-SES (HR 0.52; 95% CI 0.29-0.95), and BP-SES (HR 0.33; 95% CI 0.16-0.70) groups than in the CoCr-EES group (referent).Conclusions:
In this contemporary PCI registry, we observed the differential risks of target-vessel failure according to various types of contemporary DES in patients with CHIP characteristics. However, owing to inherent selection bias, the results should be considered hypothesis-generating, highlighting the need for further randomized trials. (Evaluation of the First, Second, and New Drug-Eluting Stents in Routine Clinical Practice [IRIS-DES]; NCT01186133).
CAD, coronary artery disease; CHIP, complex high-risk indicated procedure; CI, confidence interval; DES, drug-eluting stent(s); HR, hazard ratio; MI, myocardial infarction; PCI, percutaneous coronary intervention; TVR, target-vessel revascularization; coronary artery disease; drug-eluting stent; percutaneous coronary intervention
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Risk_factors_studies
Idioma:
En
Revista:
JACC Asia
Ano de publicação:
2022
Tipo de documento:
Article