No significant differences in efficacy, safety between drug-eluting stents

There are few significant differences in target-vessel failure with second generation drug-eluting stents (DES) for patients with left main coronary artery disease (LMCAD), according to research published on Feb. 27 in the Journal of the American College of Cardiology.


Evidence from clinical trials suggests percutaneous coronary intervention using DES is an alternative to coronary artery bypass grafting (CABG) in patients with LMCAD disease. Primary results of two trials using second-generation DES have been reported as a mixed bag. While one trial reported PCI to be non-inferior to CABG, the other study showed PCI to be inferior to CABG.


However, both studies show PCI with a DES for LMCAD revascularization has improved. However, there is little research done to examine how second-generation DES for the treatment of LMCAD was limited.


In response, a group of researchers from South Korea sought to compare the efficacy and safety of various second-generation DES for LMCAD in real-world clinical practice over a three-year period.


“There were no significant differences between stent-related and patient-related outcomes at 3-year follow-up among different types of newer generation DES for LMCA disease, except that the use of the PtCr-EES was associated with a higher risk of target-vessel failure than that of the BP-BES,” lead authors Pil Hyung Lee, MD and Osung Kwon, MD of the University of Ulsan College of Medicine in Seoul, and colleagues wrote. “Our findings should be confirmed or refuted through large, randomized clinical trials with long-term follow-up.”


The study cohort included 2,692 patients with LMCAD from three multicenter registries who received second generation DES – 1,254 received cobalt-chromium everolimus-eluting stents (CoCr-EES), 232 with biodegradable polymer biolimus-eluting stents (BP-BES), 616 with platinum-chromium EES (PtCr-EES), and 590 with Resolute zotarolimus-eluting stent (Re-ZES).


Researchers noted target-vessel failure were not significantly different for the various types of DES. There were 172 deaths of which most were cardiac-related deaths, 153 heart attacks, 122 were periprocedural heart attacks, 33 were spontaneous heart attacks, 217 repeat revascularizations, 165 were TVR and 70 were non-TVR and lastly, there were 13 major bleedings.


There were 393 patients or almost 15 percent of patients experienced at least one target-vessel failure event and 477 or almost 18 percent of patients experienced at least one MACE event. The adjusted hazard ratios for target-vessel failure were similar in between-group comparisons of the different DES. The only exception was PtCr-EES versus the BP-BES.


Additionally, there were no significant differences in MACE, any heart attacks, or any revascularization and its individual components according to the different types of DES. The three-year incidence of stent thrombosis was “considerably low” for all DES. EES platforms were favored when observing between-group differences.