title: Impact of overlapping newer generation drug-eluting stents on clinical and angiographic outcomes: pooled analysis of five trials from the international Global RESOLUTE Program.
abstract: BACKGROUND
  Overlapping first generation sirolimus- and paclitaxel-eluting stents are associated with persistent inflammation, fibrin deposition and delayed endothelialisation in preclinical models, and adverse angiographic and clinical outcomes--including death and myocardial infarction (MI)--in clinical studies.
  
  
  OBJECTIVE
  To establish as to whether there are any safety concerns with newer generation drug-eluting stents (DES).
  
  
  METHODS
  Propensity score adjustment of baseline anatomical and clinical characteristics were used to compare clinical outcomes (Kaplan-Meier estimates) between patients implanted with overlapping DES (Resolute zotarolimus-eluting stent (R-ZES) or R-ZES/other DES) against no overlapping DES. Additionally, angiographic outcomes for overlapping R-ZES and everolimus-eluting stents were evaluated in the randomised RESOLUTE All-Comers Trial.
  
  
  METHODS
  Patient level data from five controlled studies of the RESOLUTE Global Clinical Program evaluating the R-ZES were pooled. Enrollment criteria were generally unrestrictive.
  
  
  METHODS
  5130 patients.
  
  
  METHODS
  2-year clinical outcomes and 13-month angiographic outcomes.
  
  
  RESULTS
  644 of 5130 patients (12.6%) in the RESOLUTE Global Clinical Program underwent overlapping DES implantation. Implantation of overlapping DES was associated with an increased frequency of MI and more complex/calcified lesion types at baseline. Adjusted in-hospital, 30-day and 2-year clinical outcomes indicated comparable cardiac death (2-year overlap vs non-overlap: 3.0% vs 2.1%, p=0.36), major adverse cardiac events (13.3% vs 10.7%, p=0.19), target-vessel MI (3.9% vs 3.4%, p=0.40), clinically driven target vessel revascularisation (7.7% vs 6.5%, p=0.32), and definite/probable stent thrombosis (1.4% vs 0.9%, p=0.28). 13-month adjusted angiographic outcomes were comparable between overlapping and non-overlapping DES.
  
  
  CONCLUSIONS
  Overlapping newer generation DES are safe and effective, with comparable angiographic and clinical outcomes--including repeat revascularisation--to non-overlapping DES.
authors.affiliation: Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Vasim
authors.initials: V
authors.lastname: Farooq
authors.forename: Pascal
authors.initials: P
authors.lastname: Vranckx
authors.forename: Laura
authors.initials: L
authors.lastname: Mauri
authors.forename: Donald E
authors.initials: DE
authors.lastname: Cutlip
authors.forename: Jorge
authors.initials: J
authors.lastname: Belardi
authors.forename: Sigmund
authors.initials: S
authors.lastname: Silber
authors.forename: Petr
authors.initials: P
authors.lastname: Widimsky
authors.forename: Martin
authors.initials: M
authors.lastname: Leon
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Ian
authors.initials: I
authors.lastname: Meredith
authors.forename: Manuela
authors.initials: M
authors.lastname: Negoita
authors.forename: Frank
authors.initials: F
authors.lastname: van Leeuwen
authors.forename: Franz-Joseph
authors.initials: FJ
authors.lastname: Neumann
authors.forename: Alan C
authors.initials: AC
authors.lastname: Yeung
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia-Garcia
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D011474:Prosthesis Design; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents