Next-generation drug-eluting stents (DES) are associated with improved outcomes for patients undergoing percutaneous coronary intervention (PCI) in the territory of the left anterior descending (LAD) artery or left main (LM) coronary artery, according to new findings published in the Journal of the American Heart Association.
The Coronary Stent Trialist (CST) Collaboration included data from more than 26,000 patients who participated in one of 19 clinical trials.
“Although new‐generation DES have replaced BMS in contemporary practice, the evidence from individual randomized trials in supporting their use is essentially based on a lower risk of repeat revascularization procedures and stent thrombosis or MI,” wrote first author Raffaele Piccolo, MD, PhD, an interventional cardiologist at the University of Naples in Italy, and colleagues. “This latter effect has been demonstrated only in a minority of studies. The CST Collaboration was developed to comprehensively evaluate the efficacy and safety of new‐generation DES compared with BMS.”
In total, 52.4% of patients included in the study underwent LAD or LM revascularization. While 52.7% of patients were treated with a DES, the remaining patients were treated with a bare-metal stent (BMS).
Overall, treatment with a DES was associated with greater reductions in the primary outcome of cardiac death or myocardial infarction (MI) than treatment with a BMS. Patients treated with a DES also faced a lower risk of all-cause mortality—a trend that was seen in all patients, no matter which artery was involved.
Secondary outcomes for this analysis included the time to first occurrence of all-cause death, cardiac death, MI, target-vessel revascularization and definite stent thrombosis. The authors identified a “consistently beneficial effect of DES vs. BMS for both LAD and LM subgroups with respect to primary and secondary outcomes.”
The full study is available here.
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