Abstract 12041: Comparison of Second-Generation Drug-Eluting Stent With First-Generation Drug-Eluting Stent for the Treatment of Left Main and/or Three-Vessel Disease: Propensity Matched Analysis
Background: The efficacy of second-generation drug-eluting stent (DES) for left main disease (LM) and/or three vessel disease (3VD) remains unclear.
Methods: Between April 2008 and January 2013, 326 patients with LM and/or 3VD were treated by percutaneous coronary intervention. Among these patients, 154 patients were treated with first-generation DES and 137 patients were treated with second-generation DES. We performed propensity matching to minimize the impact of baseline confounding factors. Target lesion revascularization (TLR) and major adverse cardiac events (MACE) were compared between the two groups at 3 years.
Results: After propensity matching, there were 101 patients in each group. The incidence of TLR and MACE at 3 years was higher in first-generation DES compared with second-generation DES (TLR: 23.8% vs. 7.9%; P=0.003, MACE: 31.7% vs. 12.9%; P=0.002). Regarding the analysis stratified by the SYNTAX score, incidence of TLR and MACE in low and intermediate SYNTAX scores tended to be higher in first-generation DES group (low score, TLR: 14.6% vs. 5.9%; P=0.258, MACE: 18.8% vs. 11.8%; P=0.481, intermediate score, TLR: 27.3% vs. 6.5%; P=0.116, MACE: 40.9% vs. 9.7%; P=0.052). On the other hand, in high SYNTAX scores the rates of TLR and MACE were significantly higher in first-generation DES group (TLR: 35.5% vs. 11.1%; P=0.020, MACE: 45.2% vs. 16.7%; P=0.048). Cox’s proportional hazard analysis revealed that first-generation DES usage (HR 3.5, P=0.002), 2 stent for bifurcation (HR 6.8, P=0.003), calcified lesion (HR 3.7, P=0.001), and total stent length (HR 1.1, P=0.001) were predictors of TLR.
Conclusions: Second-generation DES may improve TLR and MACE in patients with LM and/or 3VD compared with first-generation DES.
Author Disclosures: N. Kobayashi: None. T. Muramatus: None. R. Tsukahara: None. Y. Ito: None. H. Ishimori: None. K. Hirano: None. M. Nakano: None.
- © 2014 by American Heart Association, Inc.