Author + information
- Mahesh Madhavan1,
- Ajay Kirtane2,
- Bjorn Redfors3,
- Philippe Généreux4,
- Pieter Smits5,
- Roxana Mehran6,
- Rupa Parvataneni7 and
- Gregg Stone8
- 1New York-Presbyterian Hospital/ Columbia University Medical Center, New York, New York, United States
- 2NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States
- 3CRF, New York, New York, United States
- 4Columbia University Medical Center/Hôpital du Sacré-Coeur de Montréal, New York, New York, United States
- 5Maasstad Ziekenhuis, Rotterdam, Netherlands
- 6Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine, New York, New York, United States
- 7crf, new york, New York, United States
- 8Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
Limited data are available regarding very late (>1 year) major adverse cardiac events (MACE) after metallic stent implantation. We therefore examined rates and predictors of very late MACE from a large pooled drug-eluting stent (DES) trial database.
Patient-level data from 17 randomized DES trials were pooled (n=21,830 patients). The primary endpoint of MACE, a composite of cardiac death, myocardial infarction (MI), or ischemia-driven target lesion revascularization (ID-TLR), was assessed up to 5 years after bare metal stents (BMS; n=2,850), and 1st (n=6,916) and 2nd generation (n=8,484) metallic DES. Landmark analysis was performed on MACE rates after the first year. Study-stratified Cox multivariable analysis was performed to determine predictors of MACE.
The overall MACE rate between years 1 to 5 was 8.5% [3.0% cardiac death, 2.9% MI, and 4.3% ischemic ID-TLR (non-hierarchical rates)]. Patients treated with BMS experienced the highest MACE rates in the first year. Conversely, between years 1 to 5, 1st generation DES were associated with the highest MACE rates (Figure). By multivariable analysis, very late MACE rates after 2nd generation DES were lower compared to 1st generation DES (HR 0.67, CI: 0.50-0.91, p=0.01), and similar compared to BMS (HR 0.93, CI: 0.70-1.24, p=0.63).
In this large-scale, patient-level, pooled study, very late MACE occurred in ∼2-3% of patients each year between 1 to 5 years with all stent types, with no plateau evident. New approaches are required to improve long-term outcomes after PCI with metallic stents.
CORONARY: PCI Outcomes