Author + information
- Manan Pareek1,
- Evald Christiansen2,
- Lisette Okkels Jensen3,
- Bent Raungaard4,
- Steen Dalby Kristensen2,
- Svend Eggert Jensen4,
- Henrik Hansen5,
- Anders Junker3,
- Karsten Veien3,
- Morten Madsen6 and
- Michael Maeng2
- 1Brigham and Women's Hospital, Boston, Massachusetts, United States
- 2Aarhus University Hospital, Aarhus, Denmark
- 3Department of Cardiology, Odense University Hospital, Odense, Denmark
- 4Aalborg University Hospital, Aalborg, Denmark
- 5Odense University Hospital, Odense, Denmark
- 6Aarhus University Hospital, Arhus N, Denmark
Limited data exist clarifying the long-term risk of target lesion revascularization (TLR) associated with distinct first and newer-generation drug-eluting stents (DES) in patients presenting with and without acute coronary syndromes (ACS).
We pooled individual patient data from the 3 randomized SORT OUT all-comer trials of DES, for which 5-year outcomes were available: SORT OUT III (Endeavor zotarolimus-eluting stent (E-ZES) vs. Cypher sirolimus-eluting-stent (SES)); SORT OUT IV (Xience V/Promus everolimus-eluting stent (EES) vs. SES), and SORT OUT V (Nobori biolimus-eluting stent (BES) vs. SES). Relative risks (RR) were calculated for TLR, using SES as reference. Landmark analyses were performed for the timeframe between 12 months to 60 months after DES deployment.
Complete data were available for 2844 patients presenting with ACS and 3680 presenting without ACS. Among patients with an ACS, 1446 received SES, 449 E-ZES, 436 EES, and 513 BES. Of these, 154 (5.4%) were subjected to TLR, with similar 5-year rates observed for those who received E-ZES (6.2%), EES (3.9%), or BES (5.3%), when compared with SES (5.7%). However, during the timeframe 12-60 months, all newer-generation DES (E-ZES: 1.7%; EES: 1.6%; BES: 2.4%) performed better than SES (4.0%). A total of 243 (6.6%) patients underwent TLR in the non-ACS group. Findings were comparable with those for the ACS group, but with less strong effect size estimates.
Beyond the first year after placement, newer generation DES offered better protection against TLR than the first-generation SES, in patients both with and without ACS.
CORONARY: Stents: Drug-Eluting