Long-term comparative effectiveness of paclitaxel-eluting and everolimus-eluting stents in New York.
OBJECTIVE
First generation paclitaxel-eluting stents (PES) and second generation everolimus-eluting stents (EES) were approved for use in percutaneous coronary interventions (PCIs) in 2004 and 2008, respectively. However, relative long-term outcomes of PES vs EES in real practice remain unclear. We sought to determine the long-term comparative effectiveness of PES vs EES using New York State (NYS) cardiac registries and to assess long-term outcomes of PES vs ZES in six "off-label" and two "high-risk" patient subgroups.


METHODS
A longitudinal database was built by linking the NYS cardiac registries, the statewide hospital discharge data, the National Death Index, and the 2010 U.S. Census file for patients undergoing either PES or EES implantation from July 2008 through December 2009. All-cause mortality, acute myocardial infarction (AMI), target lesion PCI (TLPCI), and target vessel coronary artery bypass graft (TVCABG) surgery were assessed for 9760 propensity score matched patients in the 5-year follow-up period by using the Kaplan-Meier method with further adjustment using Cox proportional hazards regression.


RESULTS
We found that compared with patients receiving PES, patients receiving EES had a significantly lower rate of 5-year TLPCI (adjusted hazard ratio <AHR>: 0.75, 95% confidence interval <CI>: 0.65-0.86), TVCABG (AHR: 0.69, 95% CI: 0.53-0.90) and a similar rate of all-cause mortality (AHR: 0.98, 95% CI: 0.87-1.10) and AMI (AHR: 0.97, 95% CI: 0.83-1.13). We observed similar findings in only two out of eight subgroups.


CONCLUSIONS
At 5years, EES was associated with lower TLPCI and TVCABG rates and comparable mortality and AMI rates relative to PES.
University at Albany-State University of New York, Albany, NY, United States. Electronic address: fqian@albany.edu.
Feng
F
Qian
University at Albany-State University of New York, Albany, NY, United States.
Ye
Y
Zhong
University at Albany-State University of New York, Albany, NY, United States.
Edward L
EL
Hannan
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009518:New York; D017239:Paclitaxel / Q000494:pharmacology*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D000068338:Everolimus; D017239:Paclitaxel
Everolimus-eluting stents (EES); Long-term outcome; Paclitaxel-eluting stents (PES)