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Five-year major clinical outcomes between first-versus second-generation drug-eluting stents in coronary chronic total occlusions: propensity score matched analysis

Session Poster session 7

Speaker Ae-Young Her

Event : ESC Congress 2017

  • Topic : interventional cardiology and cardiovascular surgery
  • Sub-topic : Coronary Intervention: Outcome
  • Session type : Poster Session

Authors : Y H Kim (Chuncheon City,KR), AY Her (Chuncheon City,KR), SW Rha (Seoul,KP), BG Choi (Seoul,KP), SY Choi (Seoul,KP), JK Byun (Seoul,KP), CU Choi (Seoul,KP), EJ Kim (Seoul,KP), CG Park (Seoul,KP), HS Seo (Seoul,KP), DJ Oh (Seoul,KP)

Authors:
Y.H. Kim1 , A.Y. Her1 , S.W. Rha2 , B.G. Choi2 , S.Y. Choi2 , J.K. Byun2 , C.U. Choi2 , E.J. Kim2 , C.G. Park2 , H.S. Seo2 , D.J. Oh2 , 1Kangwon National University Hospital - Chuncheon City - Korea Republic of , 2Korea University Guro Hospital - Seoul - Korea Republic of ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 1291-1292

Background: There is limited long-term clinical outcome data comparing first- versus second-generation drug-eluting stents (DESs) in patients with coronary chronic total occlusion (CTO) who underwent successful percutaneous coronary intervention (PCI).

Purpose: We investigated the 5-year major clinical outcomes of first- versus second-generation DESs in coronary CTO lesions.

Methods: A total of 822 consecutive patients who underwent PCI with DESs for CTO lesions were enrolled. Finally, 326 patients (first generation, n=153 vs second generation, n=173) were enrolled. To adjust baseline confounders, a propensity score matched (PSM) analysis was performed and 2 propensity-matched groups (128 pairs, n=256, C-statistic = 0.643) were generated. Cumulative major adverse cardiac events (MACEs) up to 5 years were compared between the two groups.

Results: During the 5-year follow-up, the cumulative incidences of total MACEs (HR, 2.40; 95% CI, 1.27–4.53; p=0.007) and target lesion revascularization (TLR: HR, 2.67; 95% CI, 1.14–6,28; p=0.024), target vessel revascularization (TVR: HR, 2.75; 95% CI, 1.23–6.11; p=0.013) were higher in the first-generation DESs group compared with the second-generation group after PSM (Table and Figure).

Conclusion(s): During 5-year follow-up, first-generation DESs showed higher incidence of MACEs, TLR and TVR rates in CTO patients than second-generation DESs following successful PCI. However, the incidence of total death and myocardial infarction were similar between the two groups.

Table 1. Cumulative clinical outcomes up to 5-year between first-generation and second-generation DESs
VariablesEntire patientsPropensity score-matched patientsHazard ratio (95% CI)p value
1st (n=153)2nd (n=173)p value1st (n=128)2nd (n=128)p value
Total death, n (%)4 (2.8)6 (3.5)0.7554 (3.1)1 (0.8)0.3703.39 (0.38–30.4)0.277
Cardiac death, n (%)3 (2.0)4 (2.3)NS3 (2.3)1 (0.8)0.6222.74 (0.29–26.4)0.382
Myocardial infarction (MI), n (%)4 (2.6)1 (0.6)0.1914 (3.1)1 (0.8)0.3703.88 (0.43–34.7)0.226
ST-segment elevation MI, n (%)4 (2.6)1 (0.6)0.1914 (3.1)1 (0.8)0.3703.88 (0.43–34.7)0.226
Revascularizations, n (%)38 (24.8)21 (12.1)0.00333 (25.8)12 (9.4)0.0012.37 (1.22–4.60)0.011
TLR, n (%)24 (15.7)12 (6.9)0.01222 (17.2)7 (5.5)0.0032.67 (1.14–6.28)0.024
TVR, n (%)28 (18.3)15 (8.7)0.01025 (19.5)8 (6.3)0.0022.75 (1.23–6.11)0.013
Non-TVR, n (%)19 (12.4)12 (6.9)0.09217 (13.3)8 (6.3)0.0581.77 (0.76–4.13)0.182
TLR MACEs, n (%)26 (17.0)16 (9.2)0.03724 (18.8)8 (6.3)0.0022.59 (1.16–5.78)0.020
Total MACEs, n (%)41 (26.8)26 (15.0)0.00936 (28.1)13 (10.2)<0.0012.40 (1.27–4.53)0.007

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