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Second-generation DES mostly comparable in left main CAD
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Three-year outcomes of PCI in patients with left main CAD treated with different second-generation drug-eluting stents were mostly similar, according to a pooled analysis of data from three registries.
With studies showing the improved safety and efficacy profiles of newer-generation DES, these devices have become the preferred choice for PCI in many patients, researchers wrote in the Journal of the American College of Cardiology. However, little data exist on differences between these newer-generation DES in patients with left main CAD.
For this study, the researchers pooled data from three multicenter, prospective registries — IRIS-DES, IRIS-MAIN and PRECOMBAT — to compare outcomes of PCI with various second-generation DES in patients with significant left main CAD treated from 2007 to 2015. Of the 2,692 patients included in the analysis, 1,254 received cobalt-chromium everolimus-eluting stents (Xience V, Prime, Xpedition or Alpine; Abbott Vascular), 232 received biodegradable polymer biolimus-eluting stents (BES; BioMatrix, Biosensors; and Nobori, Terumo), 616 received platinum-chromium EES (Promus Element or Premier, Boston Scientific) and 590 received zotarolimus-eluting stents (ZES; Resolute Integrity, Medtronic).
Target vessel failure — a composite of cardiac death, target vessel MI or target vessel revascularization — was the primary outcome.
At 3 years, rates of TVF did not differ significantly among patients who received cobalt-chromium EES (16.7%), biodegradable polymer BES (13.2%), platinum-chromium EES (18.7%) or ZES (14.7%).
Similarly, in multiple treatment propensity score analysis, the adjusted HRs for the primary outcome were comparable in between-group comparisons of the different DES, with the exception of a marginally higher risk for TVF with the platinum-chromium EES compared with the biodegradable polymer BES (HR = 1.6; 95% CI, 1.01-2.54).
The risks for the patient-related composite outcome of all-cause death, any MI or any revascularization and its individual components also did not vary significantly with type of DES. The 3-year incidence of stent thrombosis was less than 1% for all DES, but the researchers found between-group differences that generally favored the EES platforms.
The researchers noted that their findings need to be confirmed or refuted in larger randomized controlled trials with longer follow-up.
Despite the data, it is difficult to conclude that stents can be used interchangeably for treatment of left main CAD, Carlo Di Mario, MD, PhD, from the Careggi University Hospital in Florence, Italy, and Gioel Gabrio Secco, MD, PhD, from Santi Antonio e Biagio e Cesare Arrigo in Alessandria, Italy, wrote in an accompanying editorial.
“We can certainly conclude, however, that the very low event rate of modern second-generation drug-eluting stents, especially in a coronary artery segment responding well to stent implantation such as the left main, seriously challenges our ability to demonstrate differences among various stent platforms with relatively large registries and trials,” they wrote. “Operator preference, which practically means experience and familiarity with a given platform for the specific anatomy and technique chosen, should be valued as much as evidence from trials in stent selection.” – by Melissa Foster
Disclosures: The authors report no relevant financial disclosures. Di Mario reports he received a grant to his institution for serving as the local principal investigator of the EXCEL trial, which was sponsored by Abbott Vascular. Secco reports no relevant financial disclosures.
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