Lower risk of stent thrombosis and restenosis with unrestricted use of 'new-generation' drug-eluting stents: a report from the nationwide Swedish Coronary Angiography and Angioplasty Registry (SCAAR).
OBJECTIVE
To compare the long-term outcome after percutaneous coronary intervention with 'new-generation' drug-eluting stents (n-DES) to 'older generation' DES (o-DES), and bare-metal stents (BMS) in a real-world population.


RESULTS
We evaluated 94 384 consecutive stent implantations (BMS, n = 64 631; o-DES, n = 19 202; n-DES, n = 10 551) in Sweden from November 2006 to October 2010. All cases of definite stent thrombosis (ST) and restenosis were documented in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Older generation DES were classified as: Cypher and Cypher Select (Cordis Corporation, Miami, FL, USA), Taxus Express and Taxus Liberté (Boston Scientific Corporation), and Endeavor (Medtronic Inc.) and n-DES as: Endeavor Resolute (Medtronic Inc.), XienceV, Xience Prime (Abbott Laboratories) and Promus, Promus Element (Boston Scientific Corporation). The Cox regression analyses unadjusted and adjusted for clinical and angiographic covariates showed a statistically significant lower risk of restenosis in n-DES compared with BMS [adjusted hazard ratio (HR) 0.29; 95% confidence interval (CI): 0.25-0.33] and o-DES (HR 0.62; 95% CI: 0.53-0.72). A lower risk of definite ST was found in n-DES compared with BMS (HR 0.38; 95% CI: 0.28-0.52) and o-DES (HR, 0.57; 95% CI: 0.41-0.79). The risk of death was significantly lower in n-DES compared with o-DES (adjusted HR: 0.77; 95% CI: 0.63-0.95) and BMS (adjusted HR: 0.55; 95% CI: 0.46-0.67).


CONCLUSIONS
Percutaneous coronary intervention with n-DES is associated with a 38% lower risk of clinically meaningful restenosis, a 43% lower risk of definite ST, and a 23% lower risk of death compared with o-DES in this observational study from a large real-world population.
Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center,  Uppsala University, Uppsala,  Sweden.
Giovanna
G
Sarno
Bo
B
Lagerqvist
Ole
O
Fröbert
Johan
J
Nilsson
Göran
G
Olivecrona
Elmir
E
Omerovic
Nawzad
N
Saleh
Dimitris
D
Venetzanos
Stefan
S
James
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D001807:Blood Vessel Prosthesis; D023903:Coronary Restenosis / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000628:therapy; D054855:Drug-Eluting Stents / Q000009:adverse effects* / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D006083:Graft Occlusion, Vascular / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data; D013548:Sweden; D016896:Treatment Outcome