title: Early-generation versus new-generation drug-eluting stents in isolated chronic total occlusion: on the road to extinction?
abstract: BACKGROUND
  The performance of second-generation drug-eluting stent (DES) versus first-generation DES implantation in patients with stable angina and single chronic total occlusion (CTO) has not yet been studied. Herein, we sought to investigate whether a successful percutaneous coronary intervention (PCI) for CTO using second-generation versus first-generation polymer-coated DES improved outcomes in a setting of isolated CTO.
  
  
  METHODS
  Among 7765 patients undergoing elective PCIs between 2006 and 2011, a total of 742 single CTOs were identified. Of these, 496 had a successful PCI and 193 were implanted with DESs. The major adverse cardiovascular event (MACE) records were extracted from the national administrative database and all patients were linked to the 2-year follow-up.
  
  
  RESULTS
  When compared to first-generation DES implantation, second-generation implantation once significantly reduced risk of MACE, both at 1-year (hazard ratio [HR], 0.15; 95% confidence interval [CI], 0.06-0.36; P=.01) and 2-year follow-up (HR, 0.27; 95% CI, 0.13-0.56; P=.01). The symptom-driven target lesion revascularization (TLR) also occurred less frequently in patients with second-generation DES vs first-generation DES within 2 years of follow-up (HR, 0.15; 95% CI, 0.05-0.44; P=.03). The substantial 2-year benefit of second-generation DES over first-generation DES also persisted after incorporating a propensity score analysis for MACE (HR, 0.24; 95% CI, 0.08-0.72; P=.01) and TLR (HR, 0.15; 95% CI, 0.05-0.49; P=.04).
  
  
  CONCLUSIONS
  Successful PCI for CTO using thin-strut polymer-coated DES vs early-generation DES implantation improves outcomes after recanalization of isolated CTO in a setting of stable angina.
authors.affiliation: University Hospital of Zurich, Cardiovascular Center, Rämistrasse 100, Zurich 8046, Switzerland. milosz.jaguszewski@usz.ch.
authors.forename: Milosz
authors.initials: M
authors.lastname: Jaguszewski
authors.forename: Natasza
authors.initials: N
authors.lastname: Gilis-Siek
authors.forename: Dariusz
authors.initials: D
authors.lastname: Ciecwierz
authors.forename: Aneta
authors.initials: A
authors.lastname: Strozyk
authors.forename: Marcin
authors.initials: M
authors.lastname: Fijalkowski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Rynkiewicz
authors.forename: Marcin
authors.initials: M
authors.lastname: Gruchala
mesh_terms: D000368:Aged; D054059:Coronary Occlusion / Q000628:therapy*; D023903:Coronary Restenosis / Q000453:epidemiology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D054855:Drug-Eluting Stents / Q000145:classification*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation* / Q000379:methods / Q000639:trends*; D012189:Retrospective Studies; D016896:Treatment Outcome