First-Generation Versus Second-Generation Drug-Eluting Stents in Coronary Chronic Total Occlusions: Two-Year Results of a Multicenter Registry.
BACKGROUND
Limited data are available regarding the long-term clinical outcomes of second-generation drug-eluting stents (DES) versus first-generation DES in patients with coronary chronic total occlusion (CTO) who undergo percutaneous coronary intervention (PCI). The aim of this study was to compare the clinical outcomes of second-generation DES with those of first-generation DES for the treatment of CTO.


RESULTS
Between March 2003 and February 2012, 1,006 consecutive patients with CTO who underwent successful PCI using either first-generation DES (n = 557) or second-generation DES (n = 449) were enrolled in a multicenter, observational registry. Propensity-score matching was also performed. The primary outcome was cardiac death over a 2-year follow-up period. No significant differences were observed between the two groups regarding the incidence of cardiac death (first-generation DES versus second-generation DES; 2.5% vs 2.0%; hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.37 to 1.98; p = 0.72) or major adverse cardiac events (MACE, 11.8% vs 11.4%; HR: 1.00; 95% CI: 0.67 to 1.50; p = 0.99). After propensity score matching, the incidences of cardiac death (HR: 0.86; 95% CI: 0.35 to 2.06; p = 0.86) and MACE (HR: 0.93; 95% CI: 0.63 to 1.37; p = 0.71) were still similar in both groups. Furthermore, no significant differences were observed between sirolimus-eluting, paclitaxel-eluting, zotarolimus-eluting, and everolimus-eluting stents regarding the incidence of cardiac death or MACE.


CONCLUSIONS
This study shows that the efficacy of second-generation DES is comparable to that of first-generation DES for treatment of CTO over 2 years of follow-up.
Division of Cardiology, Department of Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.|Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Jong-Hwa
JH
Ahn
Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.|Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Jeong Hoon
JH
Yang
Division of Cardiology, Department of Medicine, Cardiovascular Center, Anam Hospital, Korea University Medical Center, Seoul, Republic of Korea.
Cheol Woong
CW
Yu
Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea.
Je Sang
JS
Kim
Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea.
Hyun Jong
HJ
Lee
Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea.
Rak Kyeong
RK
Choi
Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea.
Tae Hoon
TH
Kim
Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea.
Ho Joon
HJ
Jang
Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea.
Young Jin
YJ
Choi
Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea.
Young Moo
YM
Roh
Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea.
Won-Heum
WH
Shim
Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Young Bin
YB
Song
Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Joo-Yong
JY
Hahn
Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Jin-Ho
JH
Choi
Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Sang Hoon
SH
Lee
Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Hyeon-Cheol
HC
Gwon
Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Seung-Hyuk
SH
Choi
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D003643:Death; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016896:Treatment Outcome