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The long term safety and efficacy of 1st and 2nd generation drug eluting stents (DES) is of continued clinical importance. We aimed at exploring the potential differences in clinical outcomes between various DES types.
Methods and Results
We followed 9,584 consecutive patients undergoing PCI at our institution (years 2004-2012, mean f/u duration 4 years). Patients treated with bare metal stents 5,599 (58.4%) were compared to 3,985 (41.5%) DES counterparts. The sirolimus eluting stent (SES) was taken as the prototype DES and compared to other DESs (e.g. Paclitaxel [P], Zotarolimus-Endeavor [ZE], Zotarolinus-Resolute [ZR], Everolimus [E] and Biolimus [B] ESs), using propensity matching. Primary outcome was the rate of composite endpoint of total mortality, MI, clinically driven TVR/CABG. At 3 years, the composite end point was significantly lower in the DES vs. BMS group (20.0% vs. 26.4%; P<0.001). The comparisons between SES with each one of the 5 other DESs, were very well balanced and did not yield significant differences for the 3 year primary composite endpoint: SES vs. PES (n=350 pairs; 18.1% vs. 17.7% p=NS), SES vs. ZEES (n=474 pairs : 21.8% vs. 23.2%, p=NS), SES vs. ZRES (n=434 pairs; 16.9% vs. 11.7% p=NS), SES vs. EES (n=824 pairs; 14.2% vs. 14.1%, p=NS) and SES vs. BES (n=117 pairs; 13.7% vs. 13.4%, p=NS).
We found: 1) no differences in the cardiac prognosis between SES and other DESs, 2) the use of DES was associated with better clinical outcomes compared to BMS.
- 2013 American College of Cardiology Foundation