DES in Women Undergoing Complex PCI Revascularization
What is the safety and efficacy of second-generation drug-eluting stents (DES) in women?
The WIN-DES investigators pooled patient-level data from women enrolled in 26 randomized trials of DES. The primary endpoint was major adverse cardiovascular events (MACE) defined as a composite of all-cause mortality, myocardial infarction, or target lesion revascularization (TLR) at 3 years of follow-up.
There were 10,241 women in the pooled database, of whom 4,629 (45%) underwent complex PCI, defined as the composite of total stent length >30 mm, ≥2 stents implanted, ≥2 lesions treated, or treatment of a bifurcation lesion. Women who underwent complex percutaneous coronary intervention (PCI) had higher 3-year risk of MACE (adjusted hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.45-1.83; p < 0.0001). The benefit of second-generation DES were seen in both patients with complex as well as those undergoing noncomplex PCI, with a significantly lower 3-year risk of MACE (adjusted HR, 0.81; 95% CI, 0.68-0.96), TLR (adjusted HR, 0.74; 95% CI, 0.57-0.95), and definite or probable stent thrombosis (adjusted HR, 0.50; 95% CI, 0.30-0.83). The risk of late stent thrombosis (<0.4%/3 years) in patients treated with second-generation DES was very low overall in both complex and noncomplex PCI.
Second-generation DES have demonstrated remarkable safety and efficacy in women undergoing PCI.
The study adds to the growing data supporting the safety and efficacy of second-generation DES, and should provide further reassurance to patients undergoing contemporary PCI.
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