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Second-generation DES show better long-term efficacy outcomes than BMS
Cobalt-chromium everolimus-eluting stents were associated with improvements in a number of outcomes compared with bare-metal stents and first-generation drug-eluting stents, according to recent findings.
The researchers reviewed MEDLINE, EMBASE and Cochrane databases for studies assessing long-term efficacy and safety of durable polymer-based DES, bioabsorbable polymer-based biolimus-eluting stents (BES) and BMS.
The review yielded 51 trials comprising 52,158 patients with follow-up data for 3 years or longer. The median follow-up duration was 3.8 years.
Results indicated that cobalt-chromium everolimus-eluting stents (EES) improved definite stent thrombosis outcomes compared to BMS (HR = 0.48; 95% CI, 0.29-0.82), paclitaxel-eluting stents (PES; HR = 0.42; 95% CI, 0.27-0.64), sirolimus-eluting stents (SES; HR = 0.41; 95% CI, 0.26-0.64) and BES (HR = 0.58; 95% CI, 0.31-1).
Cobalt-chromium EES also yielded improved mortality rates compared with SES, PES or BMS. Cardiac mortality also was lower in the cobalt-chromium EES group compared with the BMS group. MI rates were higher in the BMS, SES and PES arms compared with cobalt-chromium EES.
BES yielded reduced definite or probable stent thrombosis compared with a number of other devices, including BMS (HR = 0.56; 95% CI, 0.32-0.95), PES (HR = 0.53; 95% CI, 0.31-0.89) and SES (HR = 0.58; 95% CI, 0.35-0.92).
Phosphorylcholine-based zotarolimus-eluting stents yielded less definite stent thrombosis than SES and better MI outcomes than BMS and PES.
All DES iterations improved target vessel revascularization compared with BMS.
“Second-generation DES have substantially improved long-term safety and efficacy outcomes compared with first-generation devices,” Tullio Palmerini, MD, from the Unità Operativa di Cardiologia, Policlinico S. Orsola, Bologna, Italy, and colleagues concluded. “Among the second-generation DES, durable fluoropolymer-based [cobalt-chromium] EES were associated with the lowest rates of long-term adverse events and maximum efficacy.” – by Rob Volansky
Disclosure: Palmerini reports receiving speaker fees from Abbott Vascular. Please see the full study for a list of all other authors’ relevant financial disclosures.