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New-Generation DES Outperformed Old in Swedish Registry
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Data from a Swedish registry published in the European Heart Journal have shown that new-generation drug-eluting stents are associated with substantially improved rates of stent thrombosis, restenosis and mortality compared with older-generation stents.
In the observational study, researchers from Sweden analyzed 94,384 consecutive stent implantations from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR); procedures utilized either bare-metal stents (n=64,631), new-generation DES (n=10,551) or older-generation DES (n=19,202).
In the new-generation DES group, there was a significantly lower rate of restenosis compared with both BMS (HR=0.29; 95% CI, 0.25-0.33) and older-generation DES (HR=0.62; 95% CI, 0.53-0.72). Similarly, rates of definite stent thrombosis were also lower in the new-generation DES arm compared with BMS (HR=0.38; 95% CI, 0.28-0.52) and older-generation DES (HR=0.57; 95% CI, 0.41-0.79), as was the rate of mortality compared with both BMS (adjusted HR=0.55; 95% CI, 0.46-0.67) and older-generation models (adjusted HR=0.77; 95% CI, 0.63-0.95).
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Sarno G. Eur Heart J. 2012;doi:10.1093/eurheartj/ehr479.
Perspective
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Mehdi H. Shishehbor, DO
This study is important for two reasons: One, it is a large study with more than 94,000 patients; and two, it is an all-comer study, evaluating DES in a variety of lesions. Despite having similar baseline clinical characteristics but more complex lesion morphology, second- and third-generation DES had significantly lower incidence of restenosis, target lesion revascularization and stent thrombosis. Interestingly, the rate of restenosis at 1 and 2 years was as low as 2.8% and 3.9% in the new-generation DES, respectively. Furthermore, the rate of definite stent thrombosis was only 0.5% and 0.6% at 1 and 2 years, much lower than the expected 1% to 1.5% previously reported with first-generation DES. Indeed, in this registry, both first- and new-generation DES had lower incidence of restenosis and stent thrombosis compared to BMS. The results are consistent with recent trials of third-generation DES showing superior results with newer devices.Furthermore, newer DES were associated with lower mortality; however, this has not been observed in any clinical trials. The most likely reason for lower mortality with third-generation DES is selection bias. However, it is possible that the decline in restenosis and stent thrombosis seen with newer DES may have contributed to these findings. Overall, the findings from the SCAAR registry further support the safety and efficacy of DES when placed in appropriately selected patients. The utility of IVUS and attention to appropriate sizing and stent apposition may have also contributed to these findings; however, no interaction between date of procedure and outcomes were identified. The field of coronary intervention has significantly evolved in the last 10 years; we continue to observe with interest as newer devices continue to show better safety and efficacy.
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