Comparison of Second-Generation DES for Left Main Disease

Study Questions:

How do different second-generation drug-eluting stents (DES) compare when treating left main disease?


This was a retrospective pooled analysis of 2,692 patients from three registries who underwent PCI with second-generation DES for left main coronary artery disease. Stent types that were compared included cobalt-chromium everolimus-eluting stents (CoCr-EES) (n = 1,254), biodegradable polymer biolimus-eluting stents (BP-BES) (n = 232), platinum-chromium EES (PtCr-EES) (n = 616), and Resolute zotarolimus-eluting stent (Re-ZES) (n = 590). The primary endpoint for the analysis was target vessel failure at 3 years.


There was no significant difference in the primary outcome among the different types of stents (16.7% for the CoCr-EES, 13.2% for the BP-BES, 18.7% for the PtCr-EES, and 14.7% for the Re-ZES; p = 0.15). When using propensity-score analysis, the only significant difference was noted when comparing PtCr-EES vs. BP-BES (reference) (hazard ratio, 1.60; 95% confidence interval, 1.01-2.54; p = 0.046).


Pooled analysis from three registries suggests overall similar outcomes for different second-generation DES and a signal for a higher risk of target vessel failure in PtCr-EES when compared to BP-BES.


This is a retrospective analysis focusing on target vessel failure among second-generation DES for left main disease. Given the heterogeneity of left main disease and limitation of a retrospective analysis, these data are best used to provide reassurance that all second-generation DES, which were compared, are associated with 13-18% risk of target vessel failure at 3 years. Overall rates of stent thrombosis were low (0.2-1.0%).

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease

Keywords: Chromium, Cobalt, Coronary Artery Disease, Drug-Eluting Stents, Percutaneous Coronary Intervention, Platinum, Polymers, Risk, Sirolimus, Stents, Thrombosis, Treatment Outcome

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