title: New-generation drug-eluting stents reduce stent thrombosis and myocardial infarction: a propensity-score-adjusted analysis from the multicenter REAL registry (REgistro Regionale AngiopLastiche Dell'Emilia-Romagna).
abstract: OBJECTIVE
  The aim of this study was to compare long-term clinical outcomes in patients treated with new-generation drug-eluting stent (DES) or early-generation DES in a real-world registry.
  
  
  BACKGROUND
  New-generation DESs have proved to be more effective and safer than early-generation DES in randomized trials. However, the effects of new-generation DES versus early-generation DES in everyday clinical practice deserve further verification.
  
  
  METHODS
  A propensity-score and inverse-probability weighted analysis of 5,332 patients undergoing DES implantation (2,557 new-generation and 2,775 early-generation) between January 1, 2007 and June 30, 2011 was performed, with a median follow-up of 3 years. We assessed the incidence of major adverse cardiovascular events (MACE: all-cause death, nonfatal myocardial infarction [MI], and target vessel revascularization [TVR]), and angiographic stent thrombosis (ST) during follow-up.
  
  
  RESULTS
  At 3-years, new-generation DES in comparison with early-generation DES were associated with a reduced risk of MI (5% versus 7.4%, hazard ratio [HR]=0.65, 95% confidence interval [CI]=0.51-0.82, P=0.0004) and angiographic ST (0.5% vs. 1.1%, HR=0.35, 95% CI 0.17-0.72, P=0.004), whereas, the risk of TVR (10.9% vs. 13.5%; HR 0.99, 95% CI 0.84-1.16, P=0.99) and overall MACE was not significantly different (19.2% vs. 22.4%, HR=0.94, 95% CI=0.83-1.07, P=0.35).
  
  
  CONCLUSIONS
  Our data from a large all-comers multicenter registry confirm that, in comparison with early-generation DES, the use of new-generation DES is associated with similar efficacy and increased long-term safety, because of a reduced risk of ST and MI.
authors.affiliation: Division of Cardiology, Azienda Ospedaliero-Universitaria, Parma, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Vignali
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.forename: Laura Maria Beatrice
authors.initials: LM
authors.lastname: Belotti
authors.forename: Emilia
authors.initials: E
authors.lastname: Solinas
authors.forename: Paolo
authors.initials: P
authors.lastname: Guastaroba
authors.forename: Andrea
authors.initials: A
authors.lastname: Rubboli
authors.forename: Antonio
authors.initials: A
authors.lastname: Manari
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Diego
authors.initials: D
authors.lastname: Ardissino
authors.forename: Rossana
authors.initials: R
authors.lastname: De Palma
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000601:surgery*; D003328:Coronary Thrombosis / Q000453:epidemiology / Q000517:prevention & control*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention; D057216:Propensity Score; D011446:Prospective Studies; D011474:Prosthesis Design; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: drugs; myocardial infarction; revascularization; stents; thrombosis