Abstract 21575: The Long Term Outcome after Implantation of the First and Second Generation Drug Eluting Stents in Patients with Acute Coronary Syndrome
Introduction: The long term superiority of second generation over first generation drug eluting stents (DES) implanted in patients with acute coronary syndrome (ACS) is undetermined.
Methods: This is a multicenter “all comers” registry of 436 patients with ACS, in whom percutaneous coronary intervention (PCI) utilizing DES was performed. Each of the patients obtained only one type of DES. One hundred twenty one patient received sirolimus eluting stents (SES, Cypher™), 128 — biolimus eluting stents (BES, Biomatrix™), 91 — zotarolimus eluting stents (ZES, Endeavor Resolute <6>) and 97 everolimus eluting stents (EES, Xience V™). SES were defined as first generation (DES1, n=121), while ZES, EES and BES as second generation DES (DES2, n=315).
Results: The study groups were comparable with regard to baseline demographic clinical, angiographic and procedural characteristics, except more incidents of ST elevation myocardial infarctions (STEMI) in DES 2 group (27.8% vs. 18.1%; p=0.03) There were no differences in mortality and major adverse cardiovascular and cerebrall events (MACCE) in the periprocedural period between the groups. At one year follow up the incidences of MACCE (7.6 vs. 15.7% p=0.01) and any cause mortality (1.6 vs. 5% p=0.04) were lower in the DES 2 group when compared with DES 1. There was also a trend toward lower cardiac mortality (0.8 vs. 4.4% p=0.06) and the rate of repeated revascularization (5.4 vs. 10% p=0.09) in favor of DES 2 group. The estimated long term survival, MACCE free survival and survival without repeated revascularization was higher in the DES 2 group. Implantation of the 2nd. generation DES was the only independent factor decreasing the risk of long term MACCE (RR:0.5 95% CI:0,3-0,9)
Conclusions: Despite higher number of STEMI in DES 2 group, the one year mortality was lower in this group when compared with DES1. Large randomized trial is needed to confirm this hypothesis generating registry.
- © 2010 by American Heart Association, Inc.