Long-Term Outcomes Show Superiority of Second-Generation DES
JACC in a Flash | Drug-eluting stents (DES) are safer and more effective than bare-metal stents (BMS), according to a new, long-term study published in JACC. The study also found improvements in these areas in second-generation DES over first-generation.
Data from 51 trials, including a total of 52,158 randomized patients with a follow-up period of at least 3 years, were analyzed. Trials included BMS and different types of DES, including sirolimus-eluting stents (SES), paclitaxel-eluting stents (PES), cobalt-chromium everolimus-eluting stents (CoCr-EES), platinum-chromium EES (PtCr-EES), phosphorylcholine-based zotarolimus-eluting stent (PC-ZES), Resolute ZES (Re-ZES), and biolimus-eluting stents (BES).
Median follow-up was 3.8 years. Researchers found that late safety issues that had been apparent in first-generation DES had been eliminated in second-generation DES. Additionally, second-generation DES demonstrated a substantially improved late safety and efficacy profile compared to BMS. Specifically, CoCr-EES were associated with lower rates of long-term definite stent thrombosis than BMS, PES, ESE and BES, while PC-ZES were associated with lower definite ST than SES. CoCr-EES showed lower rates of long-term death than BMS, PES and SES, with lower rates of myocardial infarction (MI) than BMS, SES, and PES. PC-ZES, SES and Re-ZES had lower rates of MI than PES. All DES were associated with significantly lower rates of target-vessel revascularization than BMS.
This study is “the largest, most comprehensive report to date comparing the long-term safety and efficacy between different types of DES and between DES and BMS,” said the authors, led by Tullio Palmerini, MD.
In an accompanying editorial comment, Stéphane Rinfret, MD, SM, and colleagues called the study “the most comprehensive appraisal to date of the long-term risks associated with the various approved stents.” They added that the analysis “provides substantial reassurance about the safety and efficacy of current-generation DES that are in common clinical use.”
- Palmerini T, Benedetto U, Biondi-Zoccai G, et al. J Am Coll Cardiol. 2015;65(23):2496-507.
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