title: A propensity score matched analysis to determine if second-generation drug-eluting stents outperform first-generation drug-eluting stents in a complex patient population.
abstract: BACKGROUND
  Drug-eluting stents (DES) are routinely used in complex patients, but the impact of 1st- versus 2nd-generation DES on clinical outcomes has not been well described. This study aimed to assess the efficacy and safety of 2nd-generation (everolimus-eluting) DES compared to 1st-generation (sirolimus- and paclitaxel-eluting) DES in a selected, higher-risk population with complex clinical and angiographic features.
  
  
  METHODS
  The study included 5693 consecutive patients with the presence of ≥ 1 predefined complex clinical and angiographic characteristic treated with either generation DES. Using propensity score matching, the clinical outcomes of 1076 patients treated with 2nd-generation DES were compared with the outcomes of a matched population treated with 1st-generation DES over 1-year follow-up.
  
  
  RESULTS
  After matching, baseline clinical and angiographic characteristics were similar between groups. At 1-year follow-up, the rate of major adverse cardiac events was 9.4% with 2nd-generation DES and 11.3% with 1st-generation DES (p=0.16). There were no significant differences in the rates of death (3.2 vs. 4.0%, p=0.30), myocardial infarction (1.6 vs. 1.3%, p=0.57), target vessel revascularization (5.9 vs. 7.3%, p=0.17) or target lesion revascularization (4.4 vs. 5.0%, p=0.50). Definite stent thrombosis was less frequent with 2nd-generation DES (0.1 vs. 0.8%, p=0.011), as was definite or probable stent thrombosis (0.7 vs. 1.6%, p=0.040).
  
  
  CONCLUSIONS
  In this propensity score matched patient population with complex features undergoing percutaneous coronary intervention, the use of 2nd-generation DES was associated with lower rates of stent thrombosis, and similar 1-year major adverse cardiac events compared to 1st-generation DES.
authors.affiliation: MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, United States.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Loh
authors.forename: Lakshmana K
authors.initials: LK
authors.lastname: Pendyala
authors.forename: Hironori
authors.initials: H
authors.lastname: Kitabata
authors.forename: Salem
authors.initials: S
authors.lastname: Badr
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: Fang
authors.initials: F
authors.lastname: Chen
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000368:Aged; D054855:Drug-Eluting Stents / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000592:standards; D011159:Population Surveillance / Q000379:methods*; D057216:Propensity Score; D011446:Prospective Studies; D013927:Thrombosis / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome
keywords: Angioplasty; Drug-eluting stents; Outcomes