Author + information
- Sa'ar Minha,
- Israel Barbash,
- Danny Dvir,
- Itsik Ben–Dor,
- Joshua Loh,
- Salem Badr,
- Lakshmana Pendyala,
- Hironori Kitabata,
- Lowell Satler,
- Augusto Pichard,
- William Suddath,
- Kenneth Kent,
- Rebecca Torguson and
- Ron Waksman
Second–generation everolimus–eluting stents (EES) have demonstrated superiority over first–generation drug–eluting stents (DES) for single vessel disease. This study aimed to compare the safety and efficacy of EES to first–generation DES in multivessel disease (MVD).
A cohort of 1,285 patients (3124 lesions) with ≥2 diseased vessels were treated with either FGS (n=1,002) or EES (n=283). The rates of death, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), definite stent thrombosis, and major adverse cardiac events (MACE; defined as the combined incidence of TVR, death and non–fatal MI) were compared at 1 year.
Baseline characteristics were mostly matched (Table) expect for lower left ventricular ejection fraction and lower incidence of stable angina in the FGS group (p=0.001 and 0.013, respectively). At 1 year, MACE rate was lower in the EES group (9.5 vs. 15.7%, p=0.01). Multivariable analysis demonstrated that the use of EES predicted a higher chance of freedom of MACE at 1 year (HR 0.58 (0.38–0.87), p=0.009, 95%CI) with similar results after adjusting for days of clopidogrel adherence.
The use of EES in patients with MVD is both safer and more effective compared to first–generation DES. This should encourage the use of EES in MVD and prompt future comparisons of second–generation DES to coronary artery bypass grafting surgery in this subset of patients.
|Variable||FGS (n=1002)||EES (n=283)||p value|
|Baseline Demographic and Clinical Characteristics|
|Men||664 (66.3%)||184 (65.2%)||0.75|
|Insulin-dependent diabetes mellitus||100 (10.1%)||35 (12.4%)||0.266|
|Hypertension||867 (86.5%)||256 (9.5%)||0.078|
|Ejection fraction (%)||0.48±0.14||0.51±0.11||0.001|
|Stable angina||297 (29.7%)||106 (37.5%)||0.013|
|Number of diseased vessels||2.41±0.60||2.28±0.48||<0.001|
|Number of implanted stents per patient||2.45±0.91||2.47±0.93||0.77|
|Clinical Safety and Efficacy at 1 year|
|Death||73 (7.3%)||5 (1.8%)||<0.001|
|Myocardial infarction (MI)||17 (1.7%)||5 (1.8%)||0.798|
|Target lesion revascularization (TLR)||65 (6.5%)||18 (6.4%)||0.866|
|Target vessel revascularization (TVR)||90 (9.3%)||23 (8.2%)||0.584|
|Stent thrombosis||14 (1.4%)||0||0.049|
|MACE (composite of death, MI & TVR)||157 (15.7%)||27 (9.5%)||0.01|
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Multivessel Disease
Abstract Category: 45. TCT@ACC–i2: Coronary Intervention, Multivessel disease
Presentation Number: 2104–262
- 2013 American College of Cardiology Foundation